Independent Physicians Embrace PE
A good article discussing the plight of independent physician practices. With about half of physicians now owned by health systems and many of the remainder owned by public equity and health plans, standalone practices are suffering. Medicare rates have increased just 10% since 2001, yet costs are up for practices by 63% in that time. Medicare rates drive commercial rates. Independent practices are getting creative to survive, including teaming up with public equity firms that own medical service organizations and tapping into their services and capital, while remaining free-standing.
(Article may require a subscription.)
#physicians #independentpractices
https://www.modernhealthcare.com/providers/mh-independent-physicians-private-equity-partnerships/
Centene Wants More Flexibility To Combat Fraud
Centene is asking the Centers for Medicare and Medicaid Services (CMS) to empower insurers to tackle fraud. It wants the agency to ease a “complex web of regulations.” In part Centene wants to be able to suspend payments to providers without waiting for government approval and expand audit capabilities. They would also be more incentivized to invest in preventive anti-fraud measures.
(Article may require a subscription.)
#fwa #centene
https://www.modernhealthcare.com/insurance/mh-centene-cms-medicaid-fraud-crackdown
NYT Says Trump Rule Will Make Deductibles Skyrocket
A New York Times analysis says the Trump administration’s proposed rule to allow more people to enroll in less generous catastrophic, high-deductible plans could mean deductibles surge to $31,000 per year.
Fair enough. Probably technically true. While I have supported the Affordable Care Act and the Exchanges, I am increasingly noting that premiums are so high that people go uninsured or become underinsured – they cannot afford to use their insurance. Might twinning high-deductible plans with Health Savings Accounts and Direct Primary Care actually help get healthcare services to people?
(Article may require a subscription.)
#exchanges #aca #obamacare #trump
https://www.nytimes.com/2026/02/26/health/obamacare-health-insurance-rollbacks.html
More MA Enrollment Coverage
A new Chartis analysis finds some interesting things about Medicare Advantage (MA) enrollment.
- MA enrollment grew just 2.5% in 2026.
- Seven states saw MA enrollment decline for the first time largely due to plan exits.
- Traditional Medicare enrollment grew by 600,000 beneficiaries this year, reversing years of decline. So, more people did choose traditional Medicare than in past years given some of the MA woes, yet MA still grew more than FFS — by about 900K from 2025 to 2026.
- Standalone prescription drug plan enrollment rose by 1.7 million members as fewer seniors opted into MA.
- A plan executive survey found that 69% of MA leaders expect their enrollment to remain flat or contract in 2027. Nearly 70% anticipate offering less benefits next year. But they do not expect a negative five-year outlook.
Additional article: https://www.healthscape.com/insights/medicare-advantage-enrollment-depicts-industry-crossroads
#medicareadvantage #enrollment
KFF On Older Adult Exchange Premiums
Healthcare policy group KFF published an analysis on the impact of rising premiums and expiration of the enhanced subsidies in the Exchanges on older Americans. Premium hikes vary by state. 60-year-old enrollees earning just above 400% of the federal poverty level no longer qualify for any federal premium assistance and face unsubsidized costs up to three times higher than younger enrollees under the law. In 46 states and Washington, D.C., benchmark silver plan premium payments at least doubled for the population. In 19 states, they at least tripled.
Additional article: https://www.kff.org/affordable-care-act/how-will-the-loss-of-enhanced-premium-tax-credits-affect-older-adults/
#exchanges #coverage #healthcare
— Marc S. Ryan
