April 8, 2024

Study Finds Enrollees Like Zero-Premium Benefit Of MA

A Harvard and Inovalon study finds that enrollees in Medicare Advantage (MA) with zero-dollar premiums are three times more likely to be minorities than white. They also are more likely to be urban. Researchers note that MA is not monolithic and that different benefit offerings appeals to enrollees. The same researchers have found that MA enrollees have fewer hospitalizations, yet more social determinant barriers. More are in Health Maintenance Organization (HMO) products which has lower costs.

I would note that MedPAC and other critical organizations simply spend too little time on these types of stats.  I would also say that these kind of advantages for low and fixed income seniors will be ruined by poor rate hikes and terrible prior authorization rules that have just been finalized. It is a real shame.


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Fitch Says Utilization Spikes Cloud MA Outlook

Fitch Ratings says recent utilization spikes will cloud Medicare Advantage’s (MA) 2024 outlook.  The increase is being caused by a return to normal utilization since the pandemic ended and I would argue the new prior authorization rule. The impact to those with a major focus on MA may be hurt the most. Fitch says earnings were just below 7% last year for the largest publicly traded insurers.  But another rating agency, Moody’s Investor Service, has found that MA margins have come down considerably between 2019 (4.9%) and 2022 (3.4%).

Additional article: https://www.beckerspayer.com/payer/payer-outlook-clouded-by-rising-medicare-utilization-fitch.html


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Clover Health Under Threat Of Delisting

Clover Health has been told it needs to increase its stock price or be listed.


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Change Healthcare Has Demand For Another Ransom

The main entity behind the Change Healthcare cyberattack, BlackCat, is thought to have kept the entirety of a $22 million ransom. Now, the affiliate who is thought to have been shorted is demanding more money for the PHI it says it has. Change Healthcare has never confirmed a ransom.

#changehealthcare #cyberattacks

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Mass Federal Lawmakers Urge Scrutiny Of Provider Group Purchase

Federal lawmakers from Massachusetts are urging federal regulators to closely scrutinize the proposed purchase of Steward Health’s provider group by Optum.

#antitrust #mergers #acquisitions  

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ACA Fraudulent Switches In Focus

Another article on the fraudulent switching of enrollees in Exchange plans from one plan to another without their knowledge.  This is fraud by brokers and agents and many are asking for federal focus.

#fwa #exchanges

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Kudos To BCBSMA For Increases To Primary Care Providers

Kudos to Blue Cross Blue Shield of Massachusetts for increasing reimbursement rates to small, independent primary care practices. Over 1,000 will benefit. Increases could be as much as 30%.

#primarycare #bcbsma

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— Marc S. Ryan

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