DAILY UPDATE: Pitch-Book Health Companies, SCOTUS and the Peaking Stock Markets

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SCOTUS: Two technology company cases involving Texas and Florida laws challenging social-media companies’ content moderation were sent to lower courts. SCOTUS thus effectively granted the companies a victory. The Supreme Court isn’t willing to blow up the internet just yet.

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PitchBook released its analysis of digital health venture capital deals done in the first quarter. The first quarter saw downturns in telehealth and digital therapeutics, but opportunities exist in mental health chatbots and care search platforms.


Amedisys, a large home health provider, plans to divest a number of care centers to an affiliate of VitalCaring Group in advance of its planned merger with UnitedHealth Group later this year.


And … ACOs may soon be able to take a breath of fresh air, as CMS shared that it has no intention of punishing them for a $2 billion urinary catheter fraud scandal that rocked the industry.  

What’s up

  • Tesla rose another 10.06% today, continuing its push higher thanks to quarterly car deliveries that beat Wall Street’s expectations. Rivian Automotive rose 6.82% today after beating projections for their own deliveries as well.
  • Paramount Global rose 5.97% on a report from the New York Times that Barry Diller’s IAC may be exploring an acquisition of the embattled entertainment company. IAC fell just 0.26%.
  • Archer Aviation popped 8.92% after the air taxi manufacturer received a $55 million investment from Stellantis.
  • Oliveda International is up 19.81% today after the olive oil company announced massive quarterly revenue growth at a key subsidiary.

What’s down

  • Chewy fell yet another 2.24% as fallout from Roaring Kitty’s stake in the company continues to rattle investors.
  • Pure Storage plunged 4.15% after UBS analysts downgraded the stock to “sell,” citing its high valuation and overhyped AI potential.
  • Home builders took a beating after Citi analysts downgraded Lennar and D.R. Horton from “neutral” to “sell,” noting the housing market will remain soft in the second half of the year. Lennar dropped 1.61%, and D.R. Horton fell 1.35%.

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 33.92 points (0.62%) to 5,509.01; the Dow Jones Industrial Average® ($DJI) climbed 162.33 points (0.41%) to 39,331.85; the NASDAQ Composite® ($COMP) rallied 149.46 points (0.84%) to 18,028.76.
  • The 10-year Treasury note yield (TNX) dipped four basis points to 4.43%.
  • The CBOE Volatility Index® (VIX) dropped to 12.03 after earlier trading at its lowest intraday level since late May.

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SCOTUS: Health policy leaders say patients, providers, and health systems should brace for more uncertainty and less stability in the healthcare system. Even routine government functions such as deciding the rate to pay doctors for treating Medicare beneficiaries could become embroiled in long legal battles that disrupt patient care or strain providers to adapt.

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DAILY UPDATE: Nurses & AI, Private Equity & CPAs, Public Companies and the Hot July Stock Markets

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Private equity gets a big accounting firm yet. The March story about private equity firm New Market Capital buying a $2.8 billion stake in accounting firm Grant Thorton was a big story. Private equity is gobbling up accounting firms, signaling a potential sea change in how accounting firms will operate in the future, with “more than half” of the top 20 accounting firms in talks with private equity.

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 14.61 points (0.27%) to 5,475.09; the Dow Jones Industrial Average® ($DJI) climbed 50.66 points (0.13%) to 39,169.52; the NASDAQ Composite® ($COMP) added 146.70 points (0.83%) to 17,879.30.
  • The 10-year Treasury note yield (TNX) rose 12 basis points to 4.47%, the highest level since May 30 and back above its 50-day moving average, a technically important move.
  • The CBOE Volatility Index® (VIX) slipped to 12.19.

Crude oil is up sharply over the last month amid rising Middle East tensions.

What’s up

What’s down

  • Chewy stock popped then dropped 6.63% after Roaring Kitty revealed a 6.6% stake in the pet products company.
  • GameStop shares fell 5.35% after CEO Ryan Cohen posted on Twitter/X for the first time in months to advertise a job opening.
  • Uber fell 2.17% and Lyft fell 0.92% on the news that Massachusetts now requires both companies to pay rideshare drivers $32.50 an hour, plus benefits.
  • Cruise stocks sank on the news that Hurricane Beryl is stronger than expected and will disrupt service throughout the Caribbean. Norwegian Cruise Line fell 5.86%, Carnival fell 5.40%, and Royal Caribbean fell 1.86%.

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The largest nursing union in the US, National Nurses United (NNU), is sounding the alarm about the use of artificial intelligence (AI) in healthcare. In April, the union’s affiliate California Nurses Association (CNA) protested an AI conference helmed by managed care consortium Kaiser Permanente. Like workers in other sectors who are worried about AI encroachment, the nurses fear that the tech is contributing to the devaluation of their skills amid what they say is already a “chronicunderstaffing crisis, nurses reported in an NNU survey of 2,300 registered nurses and members in early 2024.

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HEALTH INSURANCE: Benefits Costs are Up!

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Employers expect health benefit costs to rise by more than 5% on average in 2024 as factors like high inflation, health labor shortages, and expensive new therapies put pressure on plan spending after years of 3%–4% annual growth, early data suggests.

Preliminary results from Mercer’s 2023 National Survey of Employer-Sponsored Health Plans found that total health benefit costs could increase by as much as 6.6% per employee if companies do nothing to control spending, or an average of 5.4% if employers take steps to hold down costs.

That slight gap suggests most employers don’t plan to make cost-cutting changes to their plans—likely due to concerns about healthcare affordability, the analysis noted. Many large companies (with 500+ employees) have avoided shifting costs to employees over the last five years, resulting in little growth in deductibles and other cost-sharing requirements.

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PODCAST: Healthcare Costs are Too Low?

By Eric Bricker MD

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DAILY UPDATE: Wall Street Stocks, Dow Dogs, Commodities, Gold, the Fed, Yen and Bitcoin

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If you can believe it, Friday was the final trading day of the first half of 2024. It might be a good time to reflect on your New Year’s resolutions to see how you’re measuring up halfway through the year.

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Dogs of the Dow: The 139-year-old index has never looked more its age, with components Nike, Intel, and Boeing all down more than 30% in 2024. The Dow has gained less than 4% this year.

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But, the S&P 500 gained a sublime 15% in H1, and Nvidia alone was responsible for more than a third of that gain. The maker of AI chips surged ~150% since Jan. 1st to become the most valuable company in the USA at one point.

Going into 2024, investors were expecting the Fed to cut interest rates six times. There hasn’t been a single rate cut yet, but that hasn’t stopped the S&P from notching 31 all-time closing highs, good for the second-best tally of records this century. Stocks have overcome the Fed’s delay thanks to strong earnings, a sturdy economy, and AI fever.

Commodities soar and a currency plummets. Cocoa boomed nearly 85% over shortage concerns. Gold hit a record high last month. The Japanese yen has slumped to a 38-year low against the US dollar.

Bitcoin got a boost from new ETFs, but it’s getting boring.

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PODCAST: Shortages in Healthcare

SUPPLY DEMAND CURVE

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DAILY UPDATE: Walgreens, Healthcare Fraud and Opioids as Stock Markets Hurt

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In an interview with the Wall Street Journal, CEO Tim Wentworth said the pharmacy chain Walgreens will shutter a significant share of its 8,600 locations in the US. The closures are part of a broader attempt to boost the ailing company, which also includes reducing its stake in the primary care business VillageMD. Wentworth said the company can reassign most employees instead of conducting layoffs. Shares cratered yesterday after Walgreens whiffed on Wall Street’s earnings projections due to weak consumer spending.

And, read how some counties reduced opioid overdose deaths during the pandemic. (Politico)

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What’s up

  • Oliveda International, which makes beauty products from olive oil, rose 38.33% for no apparent reason. Maybe people just really like the feel of extra virgin olive oil on their skin?
  • Infinera popped 16.38% after Nokia announced it would acquire the telecommunications hardware manufacturer for $2.3 billion.
  • Synchrony Financial rose 6.17% after a Baird analyst initiated coverage of the financial services company with an outperform rating.
  • Regional banking stocks rose on the hopes that a good PCE reading means a better chance of the Fed cutting rates soon. Regions Financial rose 3.83%, while Citizens Financial Group rose 3.16%.

What’s down

A late round of selling in the Treasury market sent yields to fresh highs as the day ended so here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) dipped 22.39 points (0.41%) to 5,460.48; the Dow Jones Industrial Average® ($DJI) fell 45.20 points (0.12%) to 39,118.86; the NASDAQ Composite® ($COMP) lost 126.08 points (0.71%) to 17,732.6.
  • The 10-year Treasury note yield climbed nine basis points to 4.38%.
  • The CBOE Volatility Index® (VIX) moved up slightly to 12.43.

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Nearly 200 people have been charged for their roles in various health care fraud schemes across the U.S. that federal authorities say amounted to over $2.7 billion in intended losses, the Justice Department announced. Attorney General Merrick Garland said charges against 193 people, including 76 doctors, nurse practitioners, and other licensed medical professionals in 32 different federal districts. The defendants were charged over a two-week sweep involving numerous law enforcement agencies nationwide, resulting in the seizure of more than “$231 million in cash, luxury vehicles, gold, and other assets,” according to Garland.

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DAILY UPDATE: Tenet, Rivian, Yen, Public Companies and the Light Stock Markets

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Stat: 40%. That’s how much Tenet Healthcare’s shares jumped in Q1. (Yahoo Finance)

Stat: 12%. This is how much the yen has weakened so far this year against the US dollar, which has people wondering whether the Japanese government will need to intervene. (Bloomberg)

Quote: “We believe the opportunity ahead is significant.”—RJ Scaringe, CEO and co-founder of Rivian, commenting on Volkswagen Group’s plans to invest as much as $5 billion in the EV company. (CNBC)

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What’s up

  • McCormick & Co rose 4.34% after the company posted spicy earnings results, absolutely crushing estimates.
  • Arista Networks rose 3.92% after Citigroup reiterated its buy rating for the cloud company but increased its price target from $330 to $385.
  • BlackBerry is still a company, and rose 10.41% after a berry good first quarter.

What’s down

  • Walgreens Boots Alliance plummeted 22.16% due to a worse-than-expected earnings report that saw the company slash its full-year guidance.
  • Hims & Hers dropped 7.19% after Hunter Growth Capital accused the company of using a shady supplier for its new weight-loss drugs.
  • Levi Strauss crashed 15.27% in a denim downfall for the ages, with second quarter earnings missing expectations after consumers spent less on blue jeans.
  • Micron Technology slid 7.12% despite beating analyst expectations in the third quarter. Unfortunately, management isn’t as bullish as analysts about the rest of the year.
  • Chewy fell 0.03% despite a tweet from Roaring Kitty of a cartoon dog—which is apparently all it takes to move markets these days.

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The U.S. government’s final gross domestic product (GDP) estimate announced early Thursday included a downward revision to quarterly consumer spending.

Treasury yields could move on the data, especially if the report is “hotter” than expected. Yields fell Thursday following mostly soft U.S. economic readings this morning.

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 4.97 points (0.1%) to 5,482.87; the Dow Jones Industrial Average® ($DJI) rose 36.26 points (0.1%) to 39,164.06; the NASDAQ Composite® ($COMP) rose 53.53 points (0.3%) to 17,858.68.
  • The 10-year Treasury note yield lost two basis points to 4.29%.
  • The CBOE Volatility Index® (VIX) fell to 12.29, its lowest close since June 13.

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DAILY UPDATE: MSFT Teams, Deloitte, HealthcCare Cyber Attacks as Markets Lift

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The EU says Microsoft violated its antitrust laws by bundling Teams with Office, potentially setting the stage for a major fine.

And, Deloitte has billions of dollars’ worth of Medicaid contracts, but the consultancy’s eligibility systems are full of errors. (KFF Health News)

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 8.6 points (0.16%) to 5,477.9; the Dow Jones Industrial Average® ($DJI) added 15.64 points (0.04%) to 39,127.8; the NASDAQ Composite® ($COMP) climbed 87.5 points (0.49%) to 17,805.16.
  • The 10-year Treasury note yield rose 8 points to 4.32%.
  • The CBOE Volatility Index® (VIX) eased to 12.5

What’s up

What’s down

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The disastrous ransomware attacks on Change Healthcare and Ascension this year ran up staggering costs and put a spotlight on the healthcare sector’s vulnerability. But healthcare orgs are hardly new to eye-popping bills after a major hack. Analyzing attacks on organizations in 16 countries, IBM/Ponemon Institute has shown healthcare to be the industry with the highest cost per data breach for over a decade, coming in at an average hit of $10.93 million in 2023.

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DAILY UPDATE: Gun Violence, Health & Public Companies as Technology Stocks Rebound

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The U.S. surgeon general just declared gun violence a public health crisis, driven by the fast-growing number of injuries and deaths involving firearms in the country. The advisory issued by Dr. Vivek Murthy, the nation’s top doctor, came as the U.S. grappled with another summer weekend marked by mass shootings that left dozens of people dead or wounded.

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 21.43 points (0.39%) to 5,469.30; the Dow Jones Industrial Average® ($DJI) fell 299.05 points (0.76%) to 39,112.6; the NASDAQ Composite® ($COMP) gained 220.84 points (1.26%) to 17,717.65.
  • The 10-year Treasury note yield (TNX) fell slightly to 4.24%.
  • The CBOE Volatility Index® (VIX) dropped to 12.84. 

What’s up

  • Nvidia rose 6.76% as investors realized they could buy shares of the world’s biggest semiconductor company at a discounted price.
  • Trump Media & Technology Group rose another 8.50% today on the hopes of a cash infusion, as well as hype ahead of Thursday’s presidential debate.
  • Carnival popped 8.85% after it beat analyst expectations for the second quarter, and raised its profit forecast for the rest of the year.
  • Novo Nordisk rose 3.25% after its weight-loss drug Wegovy was approved in China.
  • Enovix soared 35.05% on the news that it signed a major deal to provide VR headset batteries for an as-yet-unnamed California company.

What’s down

  • Pool Corp., maker of…pools, fell 8.04% today after cutting guidance for the year ahead.
  • SolarEdge Technologies dropped 20.60% through no fault of its own—instead, a key customer declared bankruptcy, and will be unable to pay the solar power company the $11.4 million it is owed.
  • Airbus fell 9.41% after the company announced it is cutting financial guidance for the remainder of 2024 thanks to supply chain snarls and higher costs.
  • Auto dealer stocks continue to suffer the effects of a massive cyberattack on CDK, a key supplier of dealership management software. The company says its systems will remain down until June 30, but in the meantime shares of Autonation fell 2.04%, Sonic Automotive dropped 2.56%, and Group 1 Automotive slid 2.49%.

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Digital health company Sharecare has agreed to be acquired by private equity firm Altaris for $1.43 in cash per share, or about $518 million.


Nearly three months after Kaiser Permanente’s Risant Health acquired Geisinger Health, the group has now agreed to terms with Cone Health in North Carolina.


And ... UnitedHealthcare says its Surest unit improves spending and utilization across all age groups and for people with various conditions.

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RIP: Medical Debt!

By Staff Reporters

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Casey McIntyre, a 38-year-old book publisher and mother of one, helped wipe out more than $30 million in unpaid medical bills for other people…without being alive to see it. McIntyre’s husband posted a message on her behalf after she died of ovarian cancer last year, asking people to participate in a “debt jubilee” that pays off the medical bills of others. The response has been overwhelming:

As of recently, the nonprofit RIP Medical Debt has received more than $300,000 in donations through McIntyre’s campaign. The organization relieves $10,000 of medical debt for every $100

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DAILY UPDATE: Dental Staffing, Various Companies & the Stock Markets

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Here’s where the major benchmarks ended:

  • The S&P 500 index lost 16.75 points (0.31%) to 5,447.87; the Dow Jones Industrial Average ($DJI) gained 260.88 points (0.67%) to 39,411.21; the NASDAQ Composite ($COMP) dropped 192.54 points (1.09%) to 17,496.82.
  • The 10-year Treasury note yield (TNX) fell one basis point to 4.25%.
  • The CBOE Volatility Index® (VIX) ended slightly up at 13.47, the highest close since May 30.

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What’s up

What’s down

  • Nvidia dropped 6.68% as the semiconductor stock continues to fall, with the stock entering correction territory earlier today—a sentence we never thought we’d write.
  • Eli Lilly’s weight-loss drug Zepbound can also help people with sleep apnea, cutting into the sleep-aid market, sending shares of ResMed down 11.40% and Inspire Medical Systems down 16.45% on the news.
  • Bitcoin-connected stocks are taking a hit as the crypto selloff continues. Coinbase Global fell 6%, while MicroStrategy fell 7.52%.

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The dental industrylike other parts of healthcare—is facing significant staffing challenges. The US is in need of nearly 10,000 dental professionals and has more than 6,800 health professional shortage areas (HPSAs), which the US Department of Health and Human Services defines as “a geographic area, population, or facility with a shortage of primary care, dental, or mental health providers and services.”

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DAILY UPDATE: Genome Testing, the Stock Markets and Microsoft, Apple & Meta

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Apple and Meta are considering an AI partnership. The two tech giants are discussing integrating Meta’s generative AI model into Apple’s new AI platform, Apple Intelligence, the WSJ reports. Instead of building an in-house AI model, Apple opted for the partnership route and previously announced a deal with OpenAI to bring ChatGPT to iPhones. Apple has also reportedly held talks with AI startups Anthropic and Perplexity to fuse their AI models with Apple Intelligence and get that sweet, sweet distribution Apple provides.

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Genome testing can spot rare disease risks at birth. Newborn babies typically get blood tested for dozens of diseases, but some parents living in North Carolina and New York have recently been able to get their bundles of joy screened for hundreds of potentially life-threatening medical conditions that regular tests can’t catch thanks to a growing field called genomic medicine. Early results from two ongoing studies are very promising, the Washington Post reported, but scaling the new type of testing could be tricky: A full genome read (which covers all of your DNA) costs around $1,000 per patient. Still, research into the cost-benefit of genome sequencing has found that it can ultimately save families money on hospital care.

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Markets: Sweating the upcoming election? Investors aren’t. The S&P 500 is on track for its best first-half performance in an election year going back to 1976, per Dow Jones Market Data. And as trading begins Monday morning, Microsoft is back on the Iron Throne as the US’ most valuable company following Nvidia’s stumbles at the end of last week.

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BANKS: Eight Types; plus 1

DOCTORS NEED TO KNOW

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By Dr. David Edward Marcinko MBA MEd CMP

A general understanding of these bank types is suggested for any medical professional prior to launching a self-directed [ME, Inc] medical practice, clinic, guided investment strategy, personal financial plan or wealth building portfolio effort; etc.

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Understanding Bond Duration

[By Dr. David Edward Marcinko; MBA, MEd, CMP™]

fp-book1

Because of today’s stock market volatility, and virtual collapse in some banks and world equities, an interesting question often arises when the physician-investor considers investing in bonds; as more and more are doing.

Question

How much will a bond’s price change from a 1 percent change in interest rates? 

Duration Defined

To answer this, consider the concept of duration.  According to Jeff Coons PhD, CFP™, a bond’s duration is the weighted average life of its cash flows.

Thus, if your bond pays $60 per year in coupon payments for ten years and $1,000 in par value at the end of the ten years, the duration is the length of time that it takes for you to receive the present value of the coupon payments and par value. 

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Rule-of-Thumb

How does this help answer the original question?  There is a handy rule-of-thumb that says the duration of a bond times the change in market interest rates is the approximate price change of the bond.  Thus, the price of a ten-year Treasury bond with a duration of approximately 7.8 years will appreciate (decline) by about 7.8 percent with a drop (increase) in interest rates of 1 percent.

Assessment

For each of the two basic types of bonds, the duration is the following:

1. Zero-Coupon Bond – Duration is equal to its time to maturity, and

2. Vanilla Bond – Duration will always be less than its time to maturity. 

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The BANKS: https://www.fool.com/investing/2023/03/30/why-is-everyone-talking-about-duration/

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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DAILY UPDATE: Reverse Aging, Credit Card Competition Act, Nvidia and a Market Re-Cap

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The de-aging biz: Time to pull back the hospital curtain and see who’s behind the booming longevity market. This article, sponsored by Timeline, lays out who’s making $$$ on “reverse aging.*

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  • The S&P 500 and NASDAQ have often outperformed the Dow in recent years thanks to their focus on tech, as well as their market-cap weighting vs the Dow’s price weighting. When tech stocks roar higher, the younger indexes rise above their older peer—but the last few days have seen a sell off of tech stocks led by NVIDIA, bringing the S&P 500 and NASDAQ lower to end the week while the Dow has continued to rise.
  • Bonds remained unchanged for most of the day, ending the trading session flat as investors parse through a week of economic data and prepare for next week’s PCE report.
  • Gold plunged after the dollar rose, making it more expensive for gold bugs to hold the precious metal.
  • As for oil, read on to learn why crude has high hopes today but may not be a smart investment tomorrow.

Nvidia faltered for the second day in a row, falling off the world’s most valuable company perch and shedding $220+ billion in market cap. But the S&P 500 has gone 377 days without a 2.05% sell-off, the longest streak since the 2008 financial crisis, per CNBC.

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The Credit Card Competition Act is proposed legislation in Congress that could fundamentally change credit card systems. If passed, it could devastate the future of cash-back and travel rewards.

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BEWARE: Junk Health Insurance and Medical Billing Fees

By Staff Reporters

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President Joe Biden is cracking down on what the White House calls “junk” health insurance plans – namely, less-robust and short-term coverage that the Trump administration expanded as a cheaper alternative to Obamacare AHA plans.

Biden announced a draft regulation which, once finalized, would limit temporary plans to four months instead of the current three-year maximum. It would also require more disclosure on coverage limits.

“This rule would help make these plans fairer and help ensure that consumers know what they’re getting when they sign up for insurance,” said White House domestic policy advisor Neera Tanden. “When they don’t know what they’re getting and get these gigantic bills, they can feel like it’s a scam.”

CITE: https://medicalexecutivepost.com/2022/03/04/podcast-the-no-surprises-medical-billing-act/

The president also announced new guidance on medical billing stemming from 2020’s No Surprises Act. The guidance would limit the ability of insurers that contract with hospitals to claim provided care was not in network and have customers pay more money. Health plans also would need to disclose facility fees that are increasingly charged to patients and can surface as an unexpected cost in a medical bill.

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PODCAST: What is Public Health?

By American Journal of Public Health

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Public health is now part of the political conversation but everyone doesn’t understand it in the same way. Hence the idea of interviewing Governor John Kasich, former governor of Ohio, who has been promoting a greater attention to public health, about what is public health for him.

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INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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TECH: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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PODCASTS: The Physician-Patient Population Health Mis-Match

By Eric Bricker MD

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PODCAST: https://medicalexecutivepost.com/2022/10/23/podcast-help-your-medical-practice-embrace-population-health/

Population Health: https://medicalexecutivepost.com/2022/07/12/enter-population-health-management/

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PODCAST: Hospital Healthcare Finance Explained

By Eric Bricker MD

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DAILY UPDATE: Amazon Pharmacy, Healthcare Spending Boom, Companies and the Bi-Hybrid Markets

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Amazon Pharmacy announced on June 18 that, effective immediately, its RxPass medication delivery service will be available to more than 50 million Medicare beneficiaries, a move the company says could save up to $2 billion annually for the federal health insurance program.

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 8.55 points (0.2%) to 5,464.62, up 0.6% for the week; the Dow Jones Industrial Average® ($DJI) gained 15.57 points (0.04%) to 39,150.33, up 1.5% for the week; the NASDAQ Composite® ($COMP) shed 32.23 points (0.2%) to 17,689.36, little changed for the week.
  • The 10-year Treasury note yield (TNX) was little changed at 4.255%.
  • The CBOE Volatility Index® (VIX) dipped 0.06 to 13.22.

What’s up

  • Sarepta Therapeutics soared 30.14% thanks to FDA approval of Elevidys, its new Duchenne muscular dystrophy treatment.
  • Zealand Pharma rose 18.62% after Phase 1b trial results revealed its new weight-loss drug could compete with Ozempic.
  • Asana jumped 14.95% on the news that its board has approved a share repurchase program of up to $150 million of its own stock.
  • CarMax shares rose 0.37% after the company reported first-quarter earnings. The number isn’t big, but the performance is impressive considering the used car company posted a 33% decline in profits.
  • Hertz Global popped 15.95% after the company announced it was raising the size of its bond offering to $1 billion as it looks to update its fleet of rental cars.

What’s down

  • Nvidia fell another 3.22% today as the sell off continued, with investors taking profits after a record run higher.
  • Smith & Wesson Brands dropped 12.87% after the gun maker beat earnings forecasts but announced that next quarter’s sales will be lower than expected.
  • LendingTree slid 2.48% after a Bloomberg report revealed that hackers are auctioning off stolen customer data.
  • Palantir fell 6.78% after the company earned an analyst downgrade for its “gluttonous valuation,” a phrase you never want to hear as an investor.
  • Bitcoin mining stocks took a hit today, selling off after popping higher yesterday after bitcoin prices rallied. Marathon Digital Holdings dropped 7.02%, Riot Platforms fell 8.35%, and CleanSpark sank 9.81%.

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With a record number of people insured and seeking healthcare services post-pandemic, US health spend growth is outpacing GDP growth, and is expected to keep doing so through 2032, according to a June 12 report from actuaries at the Centers for Medicare and Medicaid Services (CMS). By 2032, CMS actuaries project healthcare spending will total $7.7 trillion and make up 19.7% of total US GDP, compared to $4.8 trillion and 17.6% of GDP in 2023.

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DAILY UPDATE: Bilt, Mortgage Rates, Private Equity in Behavioral Health and the Stock Markets

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Wells Fargo is losing $10 million per month on its partnership with Bilt, whose credit card offers users reward points for paying rent, and is looking to renegotiate, the WSJ reports. Apple has stopped offering its buy now, pay later program, Apple Pay Later, after partnering with outside companies, including Affirm.

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Private equity (PE) is all over healthcare, with investment firms owning more than 400 hospitals around the US. But as the country faces a mental health crisis—US Surgeon General Vivek Murthy called it the “the defining public health crisis of our time”—PE has its sights set on one of the fastest-growing areas of the industry: behavioral health care. PE has accounted for over 60% of all behavioral health deal flow since 2018, and firms like Thurston Group and Five Points Capital now own about a quarter of facilities offering behavioral health care in some states, according to a recent cross-sectional study published in JAMA Psychiatry.

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U.S. markets were closed Wednesday for the Juneteenth holiday. Here’s where the major benchmarks ended:

  • The S&P 500 index fell 13.86 points (0.3%) to 5,473.17; the Dow Jones Industrial Average® ($DJI) gained 299.90 points (0.8%) to 39,134.76; the NASDAQ Composite® ($COMP) dropped 140.64 points (0.8%) to 17,721.59.
  • The 10-year Treasury note yield (TNX) climbed about 4 basis points to 4.257%.
  • The CBOE Volatility Index® (VIX) rose 0.80 to 13.28.

What’s up

  • Gilead jumped 8.46% after clinical data revealed that its new twice-a-year shot prevents 100% of HIV cases.
  • Penn Entertainment rose 9.93% on the news that Boyd Gaming has approached its competitor with an acquisition offer.
  • Accenture rose 7.30% after the IT consulting company missed earnings estimates but more than made up for it with bullish bookings data thanks to AI.
  • Darden Restaurants rose 1.53% after a mixed earnings report. Its acquisition of Ruth’s Chris Steak House propped up earnings, while Olive Garden’s same-store sales came in flat, probably because I eat several hundred free breadsticks there every month.

What’s down

  • Trump Media & Technology Group fell 14.56% after the SEC ruled that early shareholders can resell their stock in the company, diluting new shareholders—though providing upward of $247 million in funding for the beleaguered company.
  • Nikola plummeted 31.46% after the company announced a 1-for-30 stock split in a bid to stay listed on the Nasdaq.
  • Kroger fell 3.27% despite beating analyst revenue estimates in its fiscal first quarter as investors digest the chances of the company sealing a deal to buy Albertsons.
  • Tempest Therapeutics dropped 29.47% upon the release of the latest trial data for its liver cancer treatment.
  • Jabil fell 11.45% today after the electronics supplier beat earnings estimates but warned of softer growth in the year ahead.

Mortgage rates fell below 7% last week to their lowest level since March, but this didn’t spur much extra demand.

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Whither the CERTIFIED MEDICAL PLANNER™ Marks?

Wither the CERTIFIED MEDICAL PLANNER™ Professional Certification?

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DEAR INVESTMENT ADVISORS, CPAs, FINANCIAL PLANNERS, FINANCIAL ADVISORS & INSURANCE AGENTS

We believe that:

If you do not have a market niche; you are not deeply informed
If you are not deeply informed; you can’t different yourself
If you can’t differentiate yourself; you can’t differentiate price
If you can’t differentiate price; you have no market power
If you have no market power; you have no unique knowledge
If you have no unique knowledge; you have fewer profits

If you have fewer profits; you are not likely a CMP™

CMP

PROGRAM CURRICULUM: Enter the CMPs

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MEDICAL ETHICS: Physician and Financial Organizations

Demanding High Professional Moral Standards of Self and Financing Organizations

By Dr. David Edward Marcinko MBA MEd

By Render Davis MBA

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It has been argued that physicians have abdicated the “moral high ground” in health care by their interest in seeking protection for their high incomes, their highly publicized self-referral arrangements, and their historical opposition toward reform efforts that jeopardized their clinical autonomy.

In his book Medicine at the Crossroads, Emory University professor Melvin Konnor, M.D., noted that “throughout its history, organized medicine has represented, first and foremost, the pecuniary interests of doctors.” He goes on to lay significant blame for the present problems in health care at the doorstep of both insurers and doctors, stating that “the system’s ills are pervasive and all its participants are responsible.” In order to reclaim their once esteemed moral position, physicians must actively reaffirm their commitment to the highest standards of the medical profession and call on other participants in the health care delivery system also to elevate their values and standards to the highest level.

In the evolutionary shifts in models for care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values. While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other parties to the health care delivery system to raise their ethical bar.

Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.

”Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty. Medicine’s are those plus altruism, beneficence, nonmaleficence, respect, and fairness.”

Incumbent in these activities is the expectation that the forces that control our health care delivery system, the payers, the regulators, and the providers will reach out to the larger community, working to eliminate the inequities that have left so many Americans with limited access to even basic health care. Charles Dougherty clarified this obligation in Back to Reform, when he noted that “behind the daunting social reality stands a simple moral value that motivates the entire enterprise. Health care is grounded in caring. It arises from a sympathetic response to the suffering of others.”

MORE: https://medicalexecutivepost.com/2017/02/23/healthcare-policy-on-health-and-ethics/

AMA:  Ethics this discussion

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PODCAST: A Full Course on Bio-Statistics

By Quinnipiac University

Biostatistics are the development and application of statistical methods to a wide range of topics in biology. It encompasses the design of biological experiments, the collection and analysis of data from those experiments and the interpretation of the results.

The following topics of #biostatistics are discussed in this course

⭐️ Table of Contents ⭐️ 0:00

Module 1 – Introduction to Statistics 29:13 Module 2 – Describing Data: Shape 45:44 Module 3 – Describing Data: Central Tendency 1:03:34 Module 4 – Describing Data: Variability 1:34:51 Module 5 – Describing Data: Z-scores 1:43:25 Module 6 – Probability (part I) 2:09:21 Module 6 – Probability (part II) 2:26:22 Module 7 – Distribution of Sample Means 2:41:24 Module 9 – Estimation & Confidence Intervals & Effect Size 2:56:59 Module 10 – Misleading with Statistics 3:17:43 Module 11 – Biostatistics in Medical Decision-making 4:13:36 Module 11b – Biostatistics in Medical Decision-Making: Clinical Application 4:56:51 Module 12 – Biostatistics in Epidemiology 5:05:16 Module 13 – Asking Questions: Research Study Design 5:10:15 Module 14 – Bias & Confounders 5:39:20 Module 16 – Correlation & Regression 6:06:19 Module 17 – Non-parametric Tests ⭐️

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors : Best Practices from Leading Consultants and Certified Medical Planners™ book cover

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VENTURE CAPITAL FUNDING: Digital Health Space

Investment Banking

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Venture capital funding in the digital health space cooled a bit in 2022 following a red-hot 2021. Overall, digital health companies raised $15.3 billion last year, down from the $29.1 billion raised in 2021—but still above the $14.1 billion raised in 2020, according to Rock Health a seed fund that supports digital health startups.

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Nevertheless, analysts predict VC investors and IBs will still put a good amount of money into digital health in 2024 and 2025, especially in alternative care, drug development, health information technology, artificial intelligence, EMRs and software that reduces physician workload.

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Of course. an essential first part of attracting VC interest and IB money is the crafting and presentation of your formal business plan [“pitch”] ; as well as the needed technical and managerial experience. This is crucial for success and exactly where we can assist.

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DAILY UPDATE: Wells Fargo, Public Companies as Stock Markets Extend Rally

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Wells Fargo is losing $10 million per month on its partnership with Bilt, whose credit card offers users reward points for paying rent, and is looking to renegotiate, the WSJ reports. Apple has stopped offering its buy now, pay later program, Apple Pay Later, after partnering with outside companies, including Affirm.

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Here’s where the major benchmarks ended:

  • The S&P 500 index gained 13.80 points (0.3%) to 5,487.03; the Dow Jones Industrial Average® ($DJI) added 56.76 points (0.2%) to 38,834.86; the NASDAQ Composite® ($COMP) rose 5.21 points (0.03%) to 17,862.23, a record close for the seventh day in a row.
  • The 10-year Treasury note yield (TNX) dipped more than 6 basis points to 4.215%.
  • The CBOE Volatility Index® (VIX) fell 0.45 to 12.30.

What’s up

What’s down

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And … precision medicine company Tempus AI is going public, raising $410.7 million through its initial public offering.

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DAILY UPDATE: Microsoft & Google Cyber Security Discounts as Stock Markets Rally

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  • Microsoft. According to a same-day announcement on its site, the company will give “nonprofit pricing and discounts for its security products optimized for smaller organizations, providing up to a 75% discount,” along with free cybersecurity training, assessments, and—for at least one year, the company says—Windows 10 security updates.
  • Google. The White House said that Google will “provide endpoint security advice to rural hospitals and nonprofit organizations at no cost,” as well as a pilot program designed to help rural facilities “develop a packaging of security capabilities that fit these hospitals’ unique needs.”

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What’s up

What’s down

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Here’s where the major benchmarks ended:

  • The S&P 500 index gained 41.63 points (0.8%) to 5,473.23; the Dow Jones Industrial Average® ($DJI) added 188.94 points (0.5%) to 38,778.10; the NASDAQ Composite advanced 168.14 points (1.0%) to 17,857.02.
  • The 10-year Treasury note yield (TNX) rose more than 6 basis points to 4.279%.
  • The CBOE Volatility Index® (VIX) increased 0.10 to 12.76.

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DAILY UPDATE: Done Global TeleHealth

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The NASDAQ nabbed its fifth-straight record close last week, and the S&P 500 snapped its four-day streak. Both were up for the week as investors digested data that showed inflation cooling. Adobe became the latest company to soar thanks to AI, spiking after delivering better-than-expected earnings and forecasts.

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Those who rely on ADHD medication got some bad news last week when the CDC issued a health advisory alerting patients that there may be possible “increased risks for injury and overdose,” after two executives at Done Global, a telehealth company, were arrested for fraud linked to allegedly selling Adderall over the internet. The CDC warned that as many as 30,000 to 50,000 adult patients could be affected. https://tinyurl.com/3rf5py6c

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DAILY UPDATE: Father’s Day, Medical Debt and USAA

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HAPPY FATHER’S DAY

News 4 in San Antonio Texas organized a video call with several USAA members who lost funds due to fraud — and have been left with little to no recourse. Some of them also belong to the Facebook group, USAA Fraud and Victims, which has 2,900 members. A few USAA members even reported being asked by the institution to cover the negative balances on their accounts after their money was stolen.

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The race to a $3 trillion market cap seemed like it would always be between Apple and Microsoft. But over the last twelve months, Nvidia has come roaring to the front of the pack, neck and neck with the big tech incumbents. In the last two weeks alone it has replaced Apple in the #2 spot, only to be supplanted earlier this week when Apple’s AI plans propelled it back ahead. Now, it’s anybody’s race to the next big benchmark: a $4 trillion market cap.

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In a move that could be good for patients but bad for hospitals, the Consumer Financial Protection Bureau (CFPB) on Tuesday proposed regulation that would wipe medical debt from many consumers’ credit reports. The rule is meant to help the 15 million people in the US who creditors say still have a combined $49 billion of medical debt that negatively affects their credit scores, Rohit Chopra, director of the CFPB, said during a June 11 press briefing. About 100 million people in the US have some amount of medical debt, which totals roughly $220 billion, according to data from the Peterson-KFF Health System Tracker. The proposed regulation comes after three credit-reporting conglomeratesEquifax, Experian, and TransUnion—removed paid-off medical debt and medical debts under $500 from credit reports in 2022 and 2023, respectively.

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DAILY UPDATE: Sat Healthcare Private Equity, Elder Abuse Awareness Day

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Quote: “​​When private equity gets hold of healthcare systems, it is literally a matter of life and death, so if you drive a hospital like Steward into bankruptcy, putting patients and communities at risk, you should face real consequences.”—Sen. Elizabeth Warren on a proposed federal bill to impose jail time on executives who “loot” health systems, leading to patient harm (Fierce Healthcare)

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Here’s where the major benchmarks ended:

  • The S&P 500 index fell 2.14 points (0.04%) to 5,431.60, up 1.6% for the week; the Dow Jones Industrial Average® ($DJI) lost 57.94 points (0.2%) to 38,589.16, down 0.5% for the week; the NASDAQ Composite gained 21.32 points (0.1%) to 17,688.88, up 3.2% for the week.
  • The 10-year Treasury note yield (TNX) fell more than 2 basis points to 4.215%, after earlier dropping under 4.19%, its lowest since late March.
  • The CBOE Volatility Index® (VIX) rose 0.72 to 12.66.

What’s up

  • Adobe soared 14.51% today after crushing analyst expectations when it announced earnings late yesterday.
  • Shopify rose 4.59% after it received yet another analyst upgrade. JPMorgan analysts gave the stock an overweight rating on June 11, while today Evercore analysts upgraded the company to outperform.
  • Hasbro popped 6% after the toy maker earned an upgrade to “buy” from Bank of America predicated on the company’s digital gaming strategy.

What’s down

  • Cruise stocks took a major blow today after a Bank of America report revealed that there was softer-than-expected pricing across the industry in May. Carnival fell 7.09%, Norwegian Cruise Line dropped 7.43%, and Royal Caribbean fell 4.35%.
  • RH plummeted 17% after the furniture maker reported a larger-than-expected loss in the previous quarter.
  • Stellantis fell 4.08% after the company’s CEO announced it will cut costs to compete with Chinese EV makers.
  • Penn Entertainment sank 8.66% on the news that competitor Boyd Gaming has voted in an M&A expert to its board of directors, which, combined with activist investors pushing Penn to put itself up for sale, could indicate an acquisition ahead.

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June 15th marks an important day on our calendar – Elder Abuse Awareness Day. It is a day for communities worldwide to unite in bringing attention to the challenges and difficulties faced by elders and our collective responsibility to protect and support them.

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DAILY UPDATE: Flag Day, KKR, Wells Fargo and the S&P 500

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HAPPY FLAG DAY

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Wells Fargo found that some of its employees were pretending to work — and sent them packing. More than a dozen employees in the bank’s wealth and investment management divisions were discharged last month “after review of allegations involving simulation of keyboard activity creating impression of active work,” Bloomberg reported citing disclosures filed with the Financial Industry Regulatory Authority (FINRA).

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Here’s where the major benchmarks ended:

  • The S&P 500 index gained 12.71 points (0.2%) to 5,433.74; the Dow Jones Industrial Average lost 65.11 points (0.2%) to 38,647.10; the NASDAQ Composite rose 59.12 points (0.3%) to 17,66756.
  • The 10-year Treasury note yield (TNX) fell about 5 basis points to 4.246%.
  • The CBOE Volatility Index® (VIX) declined 0.10 to 11.94.

What’s up

What’s down

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On Monday, private equity giant KKR jumped 12% after S&P Dow Jones Indices announced the company would be joining the index yesterday, along with CrowdStrike and GoDaddy, which saw their stocks jump 9% and 2%, respectively. The additions will be incorporated June 24.

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MEDICAL BILLS: Clear Health [Patient] Advocacy

By Staff Reporters

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Did you know that an estimated 30-80% of medical bills in the U.S. are incorrect?

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That’s a huge range in percentages, but even if we split it right down the middle, that means at least 50% of medical bills are wrong—50% of the medical bills that are coming into your house and mine—and most healthcare consumers don’t even realize it.

READ: https://clearhealthcareadvocacy.com/

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DAILY UPDATE: Moody, CME Fedwatch and Ever Rising Stock Markets

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On Monday, private equity giant KKR jumped 12% after S&P Dow Jones Indices announced the company would be joining the index on Friday, along with CrowdStrike and GoDaddy, which saw their stocks jump 9% and 2%, respectively. The additions will be incorporated June 24.

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Stat: 99.4%. That’s the likelihood that interest rates will stay the same after the Fed’s meeting, according to the CME Fedwatch Tool. So it looks to be more “hurry up and wait” for interest rates to start coming down. 🫤 (Business Insider)

Quote: “It’s hard to think of a time when the US economy has diverged so fundamentally from its peers.”—Mark Zandi, chief economist at Moody’s Analytics, on the strength of the US economy compared to the weakness of other major economies. The US economy is continuing to grow while economies like Germany, Japan, and Canada are falling into recession. (The Atlantic)

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 45.71 points (0.9%) to 5,421.03; the Dow Jones Industrial Average  lost 35.21 points (0.1%) to 38,712.21; the NASDAQ Composite gained 264.89 points (1.5%) to 17,608.44.
  • The 10-year Treasury note yield (TNX) fell more than 7 basis points to 4.326%.
  • The CBOE Volatility Index® (VIX) declined 0.81 to  12.04.

What’s up

What’s down

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PODCAST: Blue Cross Health Insurance Companies Must Now Compete

Second BlueBid Explained

By Eric Bricker MD

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DAILY UPDATE: Apple AI, Addus HomeCare, Waystar and the Rising Markets

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Here’s where the major benchmarks ended:

  • The S&P 500 index rose 14.53 points (0.3%) to 5,375.32; the Dow Jones Industrial Average® ($DJI) declined 120.62 points (0.3%) to 38,747.42; the NASDAQ Composite gained 151.02 points (0.9%) to 17,343.55.
  • The 10-year Treasury note yield (TNX) fell about 7 basis points to 4.398%.
  • The CBOE Volatility Index® (VIX) rose 0.13 to 12.87.

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What’s up

  • Apple shares rose 7.26%, hitting a new all-time high on hopes that the company’s AI innovations can make up for lost ground. Today’s surge reaffirmed its position as the second-largest publicly traded company in the US, retaking the #2 spot from Nvidia.
  • Affirm popped 11.04% as Apple’s newest partner, with its buy-now-pay-later loans to be embedded in Apple Pay.
  • FMC Corp rose 4% on the news that its president and CEO has stepped down. It can’t feel good when your company’s stock rises after you announce you’re leaving.
  • Calavo Growers was up 8.24% after the avocado producer announced strong second quarter results thanks to high avocado prices. Those darn millennials eating their avocado toast strike again!

What’s down

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The “A” in AI stands for Apple, the techies attending Apple’s annual Worldwide Developers Conference (WWDC) were told yesterday. CEO Tim Cook and Co. unveiled Apple Intelligence, a host of AI-powered features that will debut on iPhones, iPads, and Macs this fall.

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Addus HomeCare is making a major move to expand its business with plans to buy Gentiva’s personal care business for $350 million.


Healthcare payment software maker Waystar debuted on the public market Friday, raising $967.5 million, and marking the biggest health tech IPO since 2022. The company plans on paying off existing debt.

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DAILY UPDATE: Tele-Health, Fortune 500, Companies and the Stocks Markets

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The end has come for the Covid-19-era federal Affordable Connectivity Program, which some critics say will make telehealth access challenging for millions in rural and tribal areas. (NPR/KFF Health News)

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Here’s where the major benchmarks ended yesterday:

  • The S&P 500 index rose 13.80 points (0.3%) to 5,360.79; the Dow Jones Industrial Average® ($DJI) gained 69.05 points (0.2%) to 38,868.04; the NASDAQ Composite added 59.40 points (0.4%) to 17,192.53.
  • The 10-year Treasury note yield (TNX) rose almost 4 basis points to 4.467%.
  • The CBOE Volatility Index® (VIX) rose 0.52 to 12.74.

What’s up

  • Diamond Offshore Drilling rose 10.91% after fellow offshore drilling company Noble Corp. announced it would acquire Diamond in a cash and stock deal worth $1.6 billion total. Noble shares rose 6.08% on the news as well.
  • Crowdstrike, GoDaddy, and KKR will be added to the S&P 500 when the index rebalances at the end of the quarter. Crowdstrike rose 7.29%, GoDaddy rose 1.94%, and KKR was up 11.22% on the news.
  • Texas Pacific Land Corporation shares also rose 24.57% on the news that the company will be inducted into the S&P MidCap 400.

What’s down

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Stat: 42. That’s how many healthcare industry companies were named on the latest Fortune 500, which lists the largest corporations in the US based on revenue for fiscal year 2023. (Advisory Board)

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MUTUAL FUNDS: Terms and Definitions for Physicians

A “Need-to-Know” Glossary for all Medical Professionals

http://www.HealthDictionarySeries.org

HDS

[ME-P Staff Writers] 

ADV: A two-part form filed by investment advisors who register with the Securities and Exchange Commission (SEC), as required under the Investment Advisers Act. ADV Part II information must be provided to potential investors and made available to current investors.

Alpha: A measure of the amount of a portfolio’s expected return that is not related to the portfolio’s sensitivity to market volatility. A benchmark that uses beta as a measure of risk, a benchmark and a risk free rate of return (usually T-bills) to compare actual performance with expected performance.

For example, a fund with a beta of .80 in a market that rises 10% is expected to rise 8%.

If the risk-free return is 3%, the alpha would be –.6%, calculated as follows: (Fund return – Risk-free return) – (Beta x Excess return) = Alpha   (8% – 3%) – [.8 × (10% – 3%)] = (–) .6%   

Note: A positive alpha indicates out-performance while a negative alpha means underperformance. 

Asset allocation: Strategic asset allocation refers to the long-term targets for allocation of a percentage of a portfolio among different asset classes. In contrast, tactical asset allocation refers to short-term targets.

Average maturity: The average weighted maturity of the bonds in a portfolio providing an indication of interest rate risk.

Benchmark: An index, managed portfolio, or fund used to compare performance characteristics with the targeted portfolio or fund.

Beta: A statistically computed measure of the portfolio’s relationship to changes in market value. If, compared to the S&P 500, a fund has a beta of .80; it is expected to under perform a rising market by 20% and outperform a falling market by 20%. 

Bond: Publicly traded debt instruments that are issued by governments and corporations. The issuer agrees to pay a fixed amount of interest over a specified time period and to repay the principal at maturity.

Closed-end mutual fund: An investment company that registers shares in accordance with SEC regulations and is traded in securities markets at prices determined by investments. 

Diversification: Buying a number of different investment vehicles to protect against default of a single vehicle, thereby reducing the risk of the portfolio.

Duration: A more technical calculation of interest rate risk exposure that uses the present value of expected cash flows to be returned to the bond holder over the term of the bond. 

Fundamental analysis: An analysis of a company’s stock that focuses on the economic environment, the industry the company is in, and the company’s financial situation and operating results.

Mutual fund: A regulated investment company that manages a portfolio of securities for its shareholders.

Net asset value (NAV): The value of fund assets fewer liabilities divided by outstanding shares. 

Open-end mutual fund: An investment company that invests money in accordance with specific objectives on behalf of investors. Fund assets expand or contract based on investment performance, new investments and redemptions.

Portfolio manager: The person(s) who is/are responsible for managing the portfolio in accordance with the objectives dictated by an investor or a fund’s prospectus.

Prospectus: A disclosure document filed with the SEC and made available to prospective and current investors. The prospectus covers sales charges, expenses, investment objectives and restrictions, management fees, financial highlights, and other information. 

R-squared (R2): Relationship of a fund or portfolio’s performance to a benchmark index.

For example, a fund R-squared of .5 means only 50% of its return is explained by the index. Other factors are responsible for the balance of performance. 

SEC yield: A standardized calculation of yield over a 30-day period, sometimes quoted as the “30-day yield.” It takes into account yield-to-maturity rather than current dividends. 

Standard deviation: A statistic that looks at a series of returns and expresses the average deviation from the mean return.

Statement of additional information: A disclosure document filed with the SEC that supplements the prospectus. It is made available to investors upon request. 

Technical analysis: An analysis that focuses on trends in financial markets generally.

For example, a technical analyst may view an entire industry’s group of stocks to be declining. Although the analyst may be correct about the group of stocks as a whole, there may be exceptions represented by specific, individual companies.

Total return: The combination of investment return from income, such as dividends and interest, and appreciation or depreciation in the value of the investment (Income returns plus capital return.) 

Turnover: Under SEC rules, a figure computed that indicates how often securities in the portfolio are bought and sold. For example, if turnover is 100% over a one-year period, the securities (on average) were replaced once. 

12b-1 fee: The maximum annual fee payable from fund assets for distribution and sales costs as allowed by the SEC. 

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DAILY UPDATE: Markets, Cue Health Down, Blue Kansas Part C and the FOMC

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Markets: Stocks dropped ever so slightly to end last week as investors tried to make sense of the big jobs report. Lots of jobs = good, but lots of jobs also = interest rates likely staying the same for awhile longer (more below). AMC had a rough day, tumbling 15% as the latest meme stock craze started to fizzle.

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Blue Kansas City Exiting MA Market by 2025 Due to ‘Regulatory Demands’

Blue Cross and Blue Shield of Kansas City (Blue KC) is leaving the Medicare Advantage (MA) market at the end of 2024, the insurer announced recently. The company blamed “heightened regulatory demands and rising market and financial pressures” for the decision but said it is still focused on employer-sponsored health plans, and Medicare supplement and Affordable Care Act plans in the state.

“We explored every alternative path for our MA members and are disappointed we must exit this line of business,” said Erin Stucky, Blue KC President and CEO, in a statement. “We value our MA members and are committed to providing uninterrupted, quality service to our current MA membership through the end of 2024.”

Source: Noah Tong, Fierce Healthcare [6/3/24]

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Cue Health, founded in 2010, started with great hopes as it promised a way to accurately test for Covid-19 without needing a lab. “We designed and developed a new molecular testing platform bringing lab complexity to an easy-to-use, portable device. Now you can get the best of lab molecular testing — speed, accuracy, and versatility – at home, the office, or on the go,” the company shared on its website. The company went public (with the ticker  (HLTH) ) in 2021 at $16 and rose to $20.55 and carried that massive $2.3 billion valuation. Through 2023 and into this year, Cue unsuccessfully tried to shore up operations, get new products to market, and find new capital.

In May, however, the FDA advised customers not to use two of its products at all because they did not deliver accurate results. Finally, its board and executives threw in the towel. On May 28th, the company announced it was ceasing operations and filed for bankruptcy in Delaware’s U.S. Bankruptcy Court. The company’s assets will be sold off at an undetermined date, and the proceeds will be distributed to creditors.       

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Inflation data from the Fed meeting on Wednesday: Inflation data for May arrives in the morning, and it’s expected to show price growth held steady at 3.4% annually. In the afternoon, the FOMC will wrap up its meeting with a Jerome Powell press conference. The Fed is pretty much a lock to hold interest rates at their current level.

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DAILY UPDATE: Payroll Jobs and Longevity Up

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People whose job it is to watch the economy are shocked at how many jobs the economy added last month: Payrolls added 272,000 more jobs in May, according to employer stats the government dropped yesterday, vastly exceeding the 190,000 increase that analysts predicted.

  • The biggest job gains were in healthcare (68k jobs), government (43k), and hospitality (42k).
  • The average hourly pay increased by 0.4% from the previous month and 4.1% over the year, also exceeding analysts’ predictions.

The surprisingly strong employment gains are prompting some head-scratching since they come amid slowing economic growth as consumers pull back on spending. The job market’s resilience has dashed hopes among investors and anyone planning to take out a loan that the Fed will lower interest rates soon. For example:

  • The unemployment rate ticked up to 4% from 3.9% in April, breaking its historic streak of 27 months under 4%.
  • A survey of households revealed that the number of Americans working dropped by 408,000 from April to May.

Some economists claim the household survey fails to properly account for immigrant workers, who have been the main driver of working population growth in recent years. But others say it checks out given the general cool-down vibes in the labor market: Job openings were at a three-year low in April, and many recent college grads have struggled to find work.

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While some companies would be thrilled if everyone started living to 120, it could spell trouble for the rest of us. Experts believe that centenarians becoming anything more than an anomaly would put the world in an economic pickle and require a societal overhaul to adapt. Even without futuristic tech that enables ultra-longevity, many developed countries are already in an economic bind due to aging populations and declining birth rates. The US Census Bureau projects that people older than 64 will reach 23% of the population by 2060 (compared to 17% in 2020), which means higher retirement and healthcare costs with fewer workers to offset them.

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DAILY UPDATE: Companies and Stocks Dip as Job Growth Rises

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Bank of America analysts recently looked back at the last 100 years of stock market data, searching for asset bubbles and what indicated their approach. The nine historical bubbles they found all had one thing in common ahead of their bursting: rising volatility. But, right now the Volatility Index, or VIX, is nowhere near the highs seen before the dot-com bubble burst, which should soothe investor concerns.

CITE: https://www.r2library.com/Resource

What’s up

  • Jazz Pharmaceuticals rose 5.39% today thanks to RBC Capital reiterating its outperform rating of the stock, highlighting the potential of the company’s forthcoming essential tremor treatment.
  • CarGurus popped 4.05% after receiving a shiny new outperform rating from JMP Securities, which likes the company’s online marketplace business model.
  • Las Vegas Sands rose 3.11% today on no particular news, as did Cedar Fair, which rose 3.27%. Both are beneficiaries of the vacation season, and likely enjoyed a boost today due to nothing more than the fact that it was a sunny summer Friday.

What’s down

CITE: https://tinyurl.com/2h47urt5

Here’s where the major benchmarks ended:

  • The S&P 500 index declined 5.97 points (0.1%) to 5,346.99, up 1.3% for the week; the Dow Jones Industrial Average® ($DJI) lost 87.18 points (0.2%) to 38,798.99, up 0.3% for the week; the NASDAQ Composite® ($COMP) shed 39.99 points (0.2%) to 17,133.13, up 2.4% for the week.
  • The 10-year Treasury note yield (TNX) jumped about 15 basis points to 4.432%.
  • The CBOE Volatility Index® (VIX) fell 0.36 to 12.22.

Interest-rate-sensitive sectors including banking, real estate, and utilities were among this week’s poorest performers amid expectations the Fed is unlikely to lower rates from historically high levels. The Dow Jones Utility Average ($DJU) dropped 2.8% this week. Retailers also posted a down week. Semiconductors still clocked a firm week despite declines the past two days. The PHLX Semiconductor Index (SOX) advanced 3.2% for the week. 

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STOCK SPLITS: A Vital Equity Investing Concept for Physicians and all Investors

By Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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One important equity concept that medical professionals should be aware of is the idea of stock splits.

In a stock split, a corporation issues a set number of shares in exchange for each share held by share holders. Typically, a stock split increases the number of shares owned by a shareholder.

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For example, XYZ Corp. may declare a 2-for-1 split, which means that share holders will receive two shares for each share that they own. However, corporations can also declare a reverse stock split, such as a 1-for-2 split where shareholders would receive 1 share for every two shares that they own.


While stock splits can either increase or decrease the number of shares that a share holder owns, the most important thing to understand about stock splits is that they have no impact on the aggregate value of the shareholder’s position in the company.

Using the XYZ Corp. example above, if the stock is trading at $10 per share, an investor owning 100 shares has a 24 total position of $1,000. After the 2-for-1 split occurs the investor will now own 200 shares, but the value of the stock will adjust downward from $10 per share to $5 per share.

Thus, the investor still owns $1,000 of XYZ stock. While stock splits are often interpreted as signals from management that conditions in the company are strong, there is no intrinsic reason that a stock split will result in subsequent stock appreciation.

NVIDIA Splits: https://tinyurl.com/238yze4k

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DAILY UPDATE: +/- Stocks and Dull Market Reviews

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What’s up

What’s down

  • Victoria’s Secret shares dropped 6.37% even though the company met both earnings and revenue estimates this quarter. It’s still mid-turnaround, however, and high debt remains a concern for investors.
  • Big Lots shares tanked 18.32% after the company announced abysmal earnings thanks to core customers cutting back their spending.
  • Canopy Growth shares dropped 8.45% after the marijuana producer announced plans to sell more shares in order to keep the company afloat.
  • Five Below shares fell 10.60% after announcing unimpressive earnings as low-income customers get squeezed by inflation.
  • Nio shares dropped 6.92% after the EV maker announced slower earnings than anticipated thanks to the ongoing decline in EV sales.

CITE: https://tinyurl.com/2h47urt5

Here’s where the major benchmarks ended:

  • The S&P 500 index fell 1.07 points (0.02%) to 5,352.96; the Dow Jones Industrial Average® ($DJI) gained 78.84 points (0.2%) to 38,886.17; the NASDAQ Composite eased 14.78 points (0.1%) to 17,173.12.
  • The 10-year Treasury note yield (TNX) fell slightly to 4.285%.
  • The CBOE Volatility Index® (VIX) declined 0.05 to  12.58.

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VENTURE CAPITAL: In the Digital Health Care Space

Dr. David Edward Marcinko MBA CMP

SPONSOR: http://www.MarcinkoAssociates.com

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At Marcinko & Associates, we appreciate that Venture Capital funding for entrepreneurs in the digital health space cooled a bit in 2020-22 following a red-hot 2018-20. And, overall, digital health companies raised $15.3 billion last year, down from the $29.1 billion raised in 2021—but still above the $14.1 billion raised in 2020, according to Rock Health a seed fund that supports digital health startups.

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Nevertheless, other analysts predict VC investors and Investment Bankers will still put a good amount of money into digital health in 2024 thru 2027, especially in alternative care, drug development, health information technology, artificial intelligence, EMRs and software that reduces physician workload.

An essential first part of attracting VC interest and IB money is the crafting and presentation of your formal business plan [“elevator pitch”]; as well as the needed technical and managerial experience. This too is crucial for success and exactly where we can assist.

Of course, companies focused on scaling and growing will have different needs across the business lifecycle.

And so, no matter where you are in your journey—from seeking early funding to making final preparations for your IPO—we have equity and insightful administration solutions for you and can assist at any stage of your growth spectrum.

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DAILY UPDATE: D-Day, Digital Health, Stock Companies as Markets Zoom Up!

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Today is the 80th anniversary of D-Day: More than 60 World War II veterans flew to Paris over the weekend to take part in what organizers believe could be the final major WWII commemoration involving living veterans. American veterans will be joined by President Joe Biden and other heads of state in Normandy.

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The digital health market has had a tough year, with no IPOs in all of 2023. Comparatively, the industry saw roughly 20 public exits in 2021. The recent slowdown in the broader IPO market is linked to several trends, including high interest rates and some high-profile bankruptcies, according to Adriana Krasniansky, head of research at digital health strategy group and venture fund Rock Health’s advisory arm.

Here’s where the major benchmarks ended:

  • The S&P 500 index rose 62.69 points (1.2%) to 5,354.03; the Dow Jones Industrial Average® ($DJI) gained 96.04 points (0.3%) to 38,807.33; the NASDAQ Composite rallied 330.86 points (2.0%) to 17,187.90.
  • The 10-year Treasury note yield (TNX) fell more than 5 basis points to 4.283%, its lowest level since April 1.
  • The CBOE Volatility Index® (VIX) declined 0.53 to 12.63.

What’s up

  • Nvidia only rose 5.16% today, but it was enough to surpass Apple’s market cap, making the high-flying semiconductor stock the second most valuable public company in the US.
  • Crowdstrike rose 11.98% today after reporting better than expected fiscal first quarter earnings yesterday afternoon.
  • Guidewire Software rose 17.63% today after its beat & raise quarterly report late yesterday.
  • Stitch Fix rose 29.40% after a red-hot earnings report, completely turning around the stock’s slow slide downward this year.
  • SweetGreen popped 12.76% this afternoon after revealing that its new automated kitchens can actually save on costs and cut time for orders in the long run.

What’s down

CITE: https://tinyurl.com/2h47urt5

In case you needed more proof that we’re living in the strangest timeline: Morgan Stanley, which owns E*Trade, is contemplating kicking stock influencer Roaring Kitty off the platform. It’s concerned he manipulated GameStop stocks by…posting a meme on X. (the Wall Street Journal)

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PODCAST: Number #1 Rule for Healthcare Investing

SUPPLY-DEMAND CONSIDERATIONS

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource

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DAILY UPDATE: The Peso, Health Company News with Firmer Stock Markets

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

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Sword Health, a virtual provider of musculoskeletal care, banked a financing round of $130 million after nearly tripling its revenue in the past year.


Blue Cross and Blue Shield of Kansas City is leaving the Medicare Advantage market, citing increased regulatory demands and a relatively small MA membership.


And … Cigna laid off 261 employees from its Evernorth Care Group division in Arizona. Keep up to date with all workforce updates with Fierce Healthcare’s ongoing layoff tracker.

CITE: https://www.r2library.com/Resource

On Monday, the largest U.S.-traded, Mexico-focused fund — the iShares MSCI Mexico ETF which has more than $2 billion under management — slid 10.7% to book its largest daily percentage decrease since March 16th, 2020. Meanwhile, the Franklin FTSE Mexico ETF was off 10%, also logging its worst day in over four years, according to Dow Jones Market Data. The two funds, which traded at $57.93 and $28.78, respectively, on Monday afternoon, closed at their lowest levels since early November, according to Dow Jones Market Data. 

CITE: https://tinyurl.com/2h47urt5

June got off to a rough start on Monday when a glitch at the NYSE incorrectly made it appear that some stocks suffered steep plunges—including a 99% dip in Berkshire Hathaway. Trading in the affected stocks was quickly halted and the errors were fixed.

CITE: https://tinyurl.com/tj8smmes

What’s up

What’s down

  • Stanley Black & Decker fell 3.69% after it was downgraded at Barclays. A slowdown in consumer spending plus a slow housing market means not many people are buying fancy drills at the moment.
  • Bath & Body Works fell 12.60% after beating analyst expectations this quarter but announcing that next quarter will bring lower lower earnings.
  • Designer Brands fell 20.27% after it beat revenue expectations but missed on earnings as its turnaround continues.

Here’s where the major benchmarks ended:

  • The S&P 500 index gained 7.94 points (0.2%) to 5,291.34; the Dow Jones Industrial Average® ($DJI) added 140.26 points (0.4%) to 38,711.29; the NASDAQ Composite® ($COMP) rose 28.38 points (0.2%) to 16,857.05.
  • The 10-year Treasury note yield (TNX) fell more than 7 basis points to 4.328%.
  • The CBOE Volatility Index® (VIX) rose 0.05 to 13.16.

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DAILY UPDATE: Cyber Health Hacks, DocGo, Public Companies and Mixed Stock Markets

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Dollar General has ended a pilot program with mobile care provider DocGo, becoming the latest retailer to wind down primary care operations, spokespeople from both companies confirmed to Healthcare Brew on May 31st. The retail giant—the largest in the US by number of stores—began the healthcare partnership in 2023 after announcing ambitions to establish itself as a “health destination” two years prior. DocGo and Dollar General offered mobile health clinics with basic, preventive, and urgent care services at three stores in Tennessee. Dollar General executives previously said in a June 2023 press release that they would expand the DocGo pilot program to more stores.

CITE: https://www.r2library.com/Resource

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) rose 5.89 points (0.1%) to 5,283.40; the Dow Jones Industrial Average® ($DJI) lost 115.29 points (0.3%) to 38,571.03; the NASDAQ Composite® ($COMP) advanced 93.65 points (0.6%) to 16,828.67.
  • The 10-year Treasury note yield (TNX) declined more than 11 basis points to 4.40%, near a two-week low.
  • The CBOE Volatility Index® (VIX) rose 0.19 to 13.11.

🟢 What’s up?

What’s down?

  • GSK dropped 8.65% on the news that a Delaware court will allow scientific evidence to be heard in a series of lawsuits regarding the discontinued heartburn drug Zantac.
  • Boston Beer fell 3.25% after shareholders decided to take their winnings and run following Friday’s big pop after news of its apparent acquisition by Suntory.
  • Tractor Supply shares toppled 6.21%, likely on poor manufacturing news from the ISM Index, while Halliburton shares fell 5.34%, likely on poor oil news from OPEC+.
  • Dozens of Mexican stocks and ETFs tumbled today on the election of a new president. The steepest decline was seen by Grupo Financiero Banorte, SAB, which fell 11.38%.

CITE: https://tinyurl.com/2h47urt5

Cyberattacks around the country are wreaking havoc on the ground at targeted hospitals, but a new study shows that security breaches hurt surrounding providers, too. The research published in JAMA on May 29 found that cyberattacks led to a decrease in emergency department (ED) visits at attacked hospitals and an increase in ED patients at nearby hospitals.

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PODCAST: What is a Quality-Adjusted Life Year?

NOT A Generic Obscure Measure

By Dr. David E. Marcinko MBA MEd CMP

http://www.CertifiedMedicalPlanner.org

The quality-adjusted life year or quality-adjusted life-year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived.

It is used in economic evaluation to assess the value for money of medical interventions. One QALY equates to one year in perfect health. If an individual’s health is below this maximum, QALYs are accrued at a rate of less than 1 per year.

LINK: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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ASSESSMENT: To be dead is associated with 0 QALYs. QALYs can be used to inform personal decisions, to evaluate programs, and to set priorities for future programs

VIDEO: https://www.youtube.com/watch?v=OTmXnv2RAHw

Conclusion

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