April 18, 2024

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


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, but they have been on a huge rollercoaster over the years. And the facility fees and other revenue hospitals obtain for services that can be done at lower-cost settings is outrageous, especially as private equity and hospital systems force providers to change practice patterns to more expensive settings. It is wasteful overall.

(Article may require a subscription.)

#siteneutral #hospitals


Texas Medicaid Shakes Up Plans

As in Florida, a Texas managed care award could shake up the program and force 1.8 million to change plans.  As with FL, there were big national winners and losers.

#tx #medicaid #managedcare


FL Lawsuit On Redeterminations Set To Begin

A federal lawsuit challenging due process and notice requirements in Florida over Medicaid redeterminations is set to begin in May.

#medicaid #redeterminations #fl


Fraud In Exchange Switching Coming To Light

Excellent Kaiser Health News (KHN) article on a lawsuit over the fraudulent switching of Exchange enrollees from one plan to another.  KHN has spent a great deal of time investigating the matter and deserves credit.  If half of what is said in the lawsuit is true, people and entities need criminal charges against them.

#fwa #exchanges


— Marc S. Ryan

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