Insurtech Devoted Health Has Major Financial Raise
Medicare Advantage (MA) insurtech Devoted Health raised $112 million in its Series E funding round. Devoted has over 227,000 members, up from 142,000 in December 2023. Its Star rating averages 4.6. It is in 13 states and almost 300 counties.
Devoted is one of the tech-based startups doing well in MA, along with Clover Health and Alignment Healthcare. Each seems to be bucking the major financial pressures seen by the Big 7 MA national plans. Thus, Devoted has filed to expand into seven new states and will double its county penetration. This doesn’t mean, though, that it won’t rein in benefits due to the erosion of MA rates. It likely will do so to protect its long-term financial health.
#medicareadvantage #devotedhealth #insurtechs
Another Employer Survey Shows Healthcare Cost Trends
Another employer healthcare survey is revealing the troubles employers are having on the healthcare front. The Business Group on Health’s annual survey says employers struggle with high-cost medications, including GLP-1s, cancer costs, and expensive therapies. Employers will see a 7.8% increase in 2025. In 2024, employers say total costs per employee will jump from $17,201 to $18,639, an 8.3% increase.
(Article may require a subscription.)
#employercoverage #healthcare
https://www.modernhealthcare.com/insurance/gene-therapy-glp-1-costs-employer-2025
Drug Price Boards Could Use Medicare Negotiated Prices In Commercial World
While the Inflation Reduction Act’s Medicare drug price negotiations only covers the Medicare line, we could begin to see the negotiated prices influence the commercial lines of business. State drug price boards have been set up in a number of states and some states (via statute or procedure) could begin to use the prices for the ten Medicare drugs to set upper limits or maximum prices in their states. These boards can only impact non-ERISA commercial plans. Big Pharma is also challenging these state boards on constitutional and other grounds.
(Article may require a subscription.)
#drugpricing #ira #branddrugmakers
https://insidehealthpolicy.com/daily-news/cms-negotiated-prices-set-be-used-some-pdab-upl-processes
Prominent Nevada Health System Terms United Healthcare
Carson City, Nev.-based Carson Tahoe Health has sent a contract termination to UnitedHealthcare for Medicare Advantage and commercial lines. It is effective May 30, 2025. It cites claims and prior authorization request concerns. This is part of a trend of hospitals terming MA plans.
#hospitals #healthplans #medicareadvantage
Georgia Governor Continues To Defend Medicaid Work Requirements
Georgia Gov. Brian Kemp continues to defend Georgia’s Medicaid expansion tied to work requirements. Thus, the state is unlikely to go down the road of a more traditional expansion of Medicaid anytime soon. Kemp says going first is not always easy. The program has enrolled a small number of people eligible and a mere fraction of what traditional expansion would enroll. The GA law expands to 100% of the federal poverty limit (not 133%) and requires at least 80 hours of work, volunteer activity, schooling, or vocational rehabilitation in a month.
#ga #medicaid #workrequirements #aca #obamacare
https://apnews.com/article/medicaid-georgia-pathways-kemp-e9a884f9a4a9aab76eb39b57ca280ab1
Trends in 2024 Healthcare Utilization And Spending
The Peterson-Kaiser Family Foundation Health System Tracker has published a brief on 2024 healthcare utilization and spending thus far. Spending is now higher than before the pandemic, with utilization returning. Spending on hospital care is now growing faster than pre-pandemic, even though admissions and discharges are lower. Emergency room visits remain high and have rebounded, with other outpatient visits trending upward.
#healthcare #spending #utilization
CTM Requirements Codified by CMS
A good blog from MHK on the codification and changes of the Complaints Tracking Module process. In Medicare Advantage and Part D, Medicare beneficiaries can complain directly to Medicare as opposed to utilizing plan grievance procedures first. In the annual rule in April, the Centers for Medicare and Medicaid Services (CMS) codified the complaints process and aligns it with resolution times and extensions for plan grievance and appeals processes. It also adds new outreach requirements, which are pretty standard for plans already.
#medicareadvantage #cms
— Marc S. Ryan
