April 15, 2024

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


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 role in healthcare. Elevance is trying to build a services unit much like Optum at United and Evernorth at Cigna.

#elevancehealth #primarycare #privateequityfirms


More Potential Bad News On Prior Authorization Front For Insurers

The Centers for Medicare and Medicaid Services (CMS) Administrator, Chiquita Brooks-LaSure, signaled that the agency may look at further reforms on prior authorization (PA) down the road, although she wants to be collaborative and allow plans to make reforms on their own. 

This is bad news overall.  The provider lobby has won the hearts of lawmakers and CMS.  They have spent tens of millions doing so over the years. The health plan lobby has fallen flat on its face.

There is no doubt in my mind that the Medicare Advantage 2024 PA rule will lead to increased costs and fewer benefits for members. The interoperability rule will add costs by lowering medical service standard request timeframes as well.  CMS is playing with fire here and I am not sure they even realize it.  The pandering to providers on the issue has gone way too far.  The agency apparently has forgotten what managed care is all about.

(Article may require a subscription.)

#cms #priorauthorization #medicareadvantage #healthplans


Cybersecurity Bills Will Be Debated In Congress

Both houses of Congress are beginning to hone a strategy on legislation in light of the Change Healthcare cyberattack, but healthcare organizations are by no means aligned.  So far, the approach looks more punitive than not – setting minimum standards for cybersecurity and expanding penalties. 

I am not sure Congress understands at all the issue.  First, healthcare entities are not monolithic. There are big plans to small ones, big hospitals to small ones, and big provider groups to small ones.  Each has a different readiness.  The nation has no real strategy on cybersecurity.  There will be the need for a national plan, education, and grant funding.  Ultimately, while Change may be at fault for having lax approaches to security and business continuity, the nation’s overall lack of preparedness is clearly the fault of the federal health agencies. Congress and the Department of Health and Human Services (HHS) need to look inward.

Additional article: https://thehill.com/homenews/senate/4595777-senate-hearing-change-healthcare-cyberattack/

(Some articles may require a subscription.)

#changehealthcare #cyberattacks #hhs


At Least Four MA Plans Suing CMS Over Star Ratings

Given the huge impact if Star scores drop below 4 Star, at least four Medicare Advantage (MA) plans are suing the Centers for Medicare and Medicaid Services (CMS) over their Star scores.  In part, the plans believe proper rule-setting was not followed in adopting the so-called Tukey outlier change.

(Article may require a subscription.)

#stars #medicareadvantage #cms


Fraudster Agents Now Impacting Americans’ Tax Filings And Refunds

If the illegal changes that happened to Americans in the Exchanges was not bad enough, citizens are now having issues submitting tax returns due to the fraud committed by unscrupulous insurance agents who illegally change people’s plan choices on the Exchange. Any agents should be severely punished.

#fwa #exchanges


MedPAC On To Something In Investigating Vast Price Differences

MedPAC is on to something in its review of vast differences in Part D drug costs even at the same retail drug chain. Some of this is availability.  The issue cries for expansion of drug price negotiations as well as changes to the entire opaque drug channel.

#drugpricing #medpac #drugshortages


States Passing Price Transparency Laws As Well

A good Health Affairs Forefront blog on state’s passing price transparency laws in healthcare as well.

(Article may require a subscription.)

#pricetransparency #healthplans #hospitals


Marty Makary Right On Non-Profit Hospitals

A great opinion piece by the brilliant Marty Makary, one of the best health policy experts in America.  He makes a compelling case on how non-profit hospitals need to be held accountable and that they need to meet their charitable purpose if they are to receive all sorts of tax breaks.

#martymakary #hospitals #charitycare


— Marc S. Ryan

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