Facing pushback from Louisiana regulators, the governor and some lawmakers, BCBSLA has again withdrawn its application for sales to Elevance Health. BCBSLA sought permission to transition to a for-profit entity.
Additional article: https://www.modernhealthcare.com/mergers-acquisitions/elevance-health-blue-cross-louisiana-merger-called-off
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#bcbsla #elevancehealth
Private equity firms’ investment in the Medicare Advantage (MA) space are way down from a peak in 2021. This is a sign that rising medical expense and regulation is impacting the industry. Just 4 deals occurred in 2023, down from 19 in 2021.
Additional article here: https://www.modernhealthcare.com/finance/private-equity-medicare-advantage-pesp-report
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#medicareadvantage #privatequityfirms
Kaiser Permanente moved from a $1 billion loss in 2022 to about breakeven at least in terms of operating income in 2023. Its income was $4.1 billion with investments. It reached the $100 billion mark in both operating revenues and expenses.
#kaiserpermanente #managedcare
A bipartisan group of senators will tackle long-term reform of the Medicare physician pay formula. On 1/1, a 3.4% reduction went into effect due to the existing formula. Some have accused physicians of spending more time lobbying on health plan prior authorization reform than on their own rate issues.
#medicare #physicians
A lesson for employer groups as weight-loss drugs take off in popularity. An analysis of data says that just 25 of over 6,200 prescribers in the North Carolina State Employee Plan accounted for 8 percent of the costs of prescriptions for costly weight loss drugs. These include GLP-1 meds Wegovy and Saxenda. These drugs accounted for 10% of total costs – or over $100 million.
The state wanted to rein in costs with some ideas, but its pharmacy benefit manger shot them down.
Shame on the healthcare players to not work with employers battling these cost issues.
As important, there are telehealth entities now emerging, backed by private equity, advertising solely to prescribe such meds. It is corrupt.
#weightlossdrugs #drugpricing
House Republicans passed a bill to ban the use of the controversial Quality Adjusted Life Years (QALY) measurement in federal programs.
Additional article here: https://www.fiercehealthcare.com/payers/house-republicans-vote-ban-pricing-metrics-federal-programs
#qalys #medicare #medicaid
Centene reported good numbers to Wall Street today, with notable increases in its Exchange line of business. Medicaid enrollment dropped due to redeterminations.
But like Humana, Centene is cautioning that the Medicare Advantage (MA) 2025 rate announcement was inadequate and could lead to further benefit and other changes in its MA line. It also notes that other regulatory changes are impacting its MA investment. Centene has already pared back benefits and geographies to bring its MA line to a better financial position.
Additional articles here: https://www.modernhealthcare.com/insurance/centene-medicare-advantage-rate-cut-2025-sarah-london and https://www.healthcaredive.com/news/centene-medicare-advantage-rate-drop-2023-earnings/706620/
Two other articles on the fallout from MA rates and regulatory changes here: https://www.modernhealthcare.com/insurance/medicare-advantage-rate-cut-2025-reimbursements-benefits-unitedhealth-humana and https://www.statnews.com/2024/02/05/cano-health-bankruptcy-medicare-advantage/
These articles underscore what I said in these blogs: https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ and https://www.healthcarelabyrinth.com/2025-rates-for-medicare-advantage-plans-look-tight/
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#centene #medicareadvantage
Showing that healthcare remains a risky place, Cano Health announces bankruptcy and a spectacular collapse for the provider organization that enters into risk arrangements with Medicare Advantage (MA) and Medicaid managed care. The MA market has been tough for both plans and providers. The new CEO has been trying to refocus efforts in better market areas by exiting questionable areas. Questions are being raised about why Humana, a major stakeholder, will not buy the firm outright.
Additional articles here: https://www.modernhealthcare.com/digital-health/cano-health-bankruptcy-mark-kent and https://www.healthcaredive.com/news/cano-health-chapter-11-bankruptcy-restructuring-agreement/706546/
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#medicareadvantage #humana #providers
Cigna CEO David Cordani told investors today that he believes in Medicare Advantage (MA) but it is better for his service business, not his insurance line. In an upbeat investor call, Cordani said that the Medicare line would have required major investments that were not justified based on the size of the portfolio, but that Medicare holds great promise as a service element of its growing Evernorth business. He said Cigna will double down on Evernorth grow. Its report on medical loss ratio was very good as were the financials. Some still question the decision to shed the MA lives. In the current environment for MA, Cordani’s decision may look right. But will it be the right one over the long term? Or, is this a short-term calculation and Cordani will go back after Humana again down the road? Stay tuned.
Additional articles here: https://www.modernhealthcare.com/finance/cigna-evernorth-health-services-medicare-advantage-sale-hcsc and https://www.managedhealthcareexecutive.com/view/cigna-s-2023-revenue-grew-8-to-195-3-billion and https://www.healthcaredive.com/news/cigna-medicare-evernorth-2024-outlook/706346/
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#medicareadvantage #cigna #humana
This article focuses on Medicare Advantage (MA) troubles – rates, utilization, medical expense, and punitive regulatory requirements – and how they impact insurers, value-based-care providers, and vendors. My intel suggests that the traditionally flush global and partial risk funds that insurers have with providers around the country (providers share in profits when they help reduce costs and improve quality) have dried up or are drying up. Providers are already attacking insurers on numerous issues and this development will only make such relationships even worse.
Note as well the reference to MA plans emphasizing profitability by reining in market growth and benefits. I say just this in my blog on the topic here: https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ . As well, see my just published blog on the 2025 MA payment proposal: https://www.healthcarelabyrinth.com/2025-rates-for-medicare-advantage-plans-look-tight/
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#medicareadvantage #vbc #providers
