Elevance Health Reports Positive Q1 News Elevance Health reported overall good numbers for Q1 2024.  While membership has dropped in Medicare Advantage (MA) and Medicaid, margins were up and it reported little fallout on the Medicare medical expense or Change cyberattack front. Due to the MA rate cut, Elevance will balance business expansion with margin. On the call, the CEO also discussed the need to excel at Star measurement in MA.  It also continues to build its Carelon services unit. Additional articles: https://www.fiercehealthcare.com/payers/elevance-health-sees-double-digit-profit-growth-q1-posting-22b-earnings and https://www.modernhealthcare.com/insurance/elevance-health-medicaid-medicare-advantage-earnings (Some articles may require a subscription.) #elevancehealth #medicareadvantage https://www.healthcaredive.com/news/elevance-health-earnings-q1-change-cyberattack-medicaid-medicare-advantage/713521 Lawmaker-Physician Burgess Calls For Site-Neutral Policies Retiring Rep. Michael Burgess, a physician, is calling on the Biden administration to implement site-neutral payments for hospitals, arguing it could be a way to free up dollars to overhaul the physician payment formula in Medicare and lower overall costs.  He is right! I am not always sympathetic to physicians,

Many Healthcare Bankruptcies Linked To PE Firms I often talk about the pernicious impact that private equity firms have on healthcare.  Where the firms are successful, they tend to drive up costs in the system by buying provider groups, including owning emergency room providers, and pushing for huge payouts in No Surprises Act (NSA) arbitrations.  They also own hospitals where they cut costs due to high debt. Quality of course suffers and patient care takes a back seat. Such firms also force providers to practice at high-cost hospital places of service (the same is true for hospitals who are independent but are buying up doc groups). But the other pernicious impact is on shoddy investments and the churn and fallout that occurs.  PE firms tend to saddle the entities they buy with debt.  What’s more, some of the investments are questionable and speculative.  A new report says that more than

Affiliate Of BlackCat Reportedly Published PHI From Change Cyberattack While the main operator of BlackCat ransomware appears to have kept a rumored $22 million ransom paid by United HealthGroup, an affiliate published data from the Change Healthcare cyberattack after United did not pay an additional ransom.  The affiliate controlled the captured PHI and data. #changehealthcare #cyberattacks https://www.fiercehealthcare.com/payers/optums-change-healthcare-responding-cybersecurity-issue United Reports Stabilization of MA And Costs Of Cyberattack United HealthGroup reported two critical factors on Tuesday.  First, Medicare Advantage (MA) costs have stabilized in Q1 2024.  Second, the Change Healthcare cyberattack will cost up to $1.6 billion.  The costs will likely far exceed this estimate. Additional articles: https://www.modernhealthcare.com/insurance/change-healthcare-update-cyberattack-cost-unitedhealth and https://www.healthcaredive.com/news/change-cyberattack-unitedhealth-cost-q1-earnings/713288/ and https://www.beckerspayer.com/payer/medicare-advantage-costs-begin-to-stabilize-unitedhealth-says.html (Some articles may require a subscription.) #unitedhealthcare #changehealthcare #cyberattacks #medicareadvantage https://www.fiercehealthcare.com/payers/unitedhealth-says-seasonal-pressures-ma-utilization-eased-q1 Lawmakers Receptive To Provider Recommendations On Cyber Security With United HealthGroup declining an invitation to attend a congressional hearing, lawmakers largely were empathetic to providers’ views on the cyber

Some Big Insurers May Lose Medicaid Contracts In Florida Humana, Centene, and Elevance Health were the three big plans to win Florida Medicaid awards moving forward along with a number of local plans. But UnitedHealthcare, Aetna, Molina Healthcare, and AmeriHealth Caritas Florida were not given awards. Many states are seeking to cultivate local plans. Appeals will likely follow from the three big plans not selected. Additional article here: https://www.fiercehealthcare.com/payers/unitedhealth-cvs-molina-big-losers-florida-medicaid-contract-awards #medicaid #fl #managedcare #healthplans https://www.healthcaredive.com/news/florida-medicaid-awards-centene-elevance-humana-unitedhealth-cvs-molina/713154 Carelon And Private Equity Firm Partner On Primary Care Elevance Health announced that its service unit Carelon will partner with private equity firm Clayton, Dubilier & Rice and its assets, Apree Health and Millennium Physician Group on advancing primary care.  About 1 million will be covered. The move seeks to drive a close relationship between primary care and Elevance as an insurer.  The move is a bit of a surprise given the extreme focus on private equity’s

Physician Pay Increases, But Hurt By Inflation A survey of physicians shows that pay increased by about 3% in 2023, but it was offset by high inflation. #physicians #providers https://www.fiercehealthcare.com/providers/physician-pay-rose-modest-3-2023-here-are-specialties-saw-biggest-gains Corporate And Hospital Ownership Of Physicians Continues I often talk about the pernicious effect of hospital and private equity ownership on healthcare costs. Hospitals drive changes in practice to higher-cost settings.  Together, the entities continually push fees higher. The ugly effects of the takeover of independent practices continues.  Not too long ago, studies showed about half of all physician entities owned by hospitals or private corporations and about 70% of all physicians employed by them.  Now, the latest stats show the two types of entities owning 58.5% of all physician entities.  They now own 77.6% of all physicians. For the first time, corporate practice ownership (30.1%) exceeded hospital and health system ownership of docs (28.4%). Additional article: https://www.fiercehealthcare.com/providers/more-and-more-physicians-are-working-under-hospitals-corporate-entities-report-finds #physicians #providers