December 18, 2023

More “Retail Meets Healthcare” Investments

Kroger is piloting value-based primary care clinics like many other retailers. The grocery chain will team up with Better Health Group, a provider network, to build out primary care centers.  Kroger in-store clinics will be replaced. There is a senior focus.

Walgreens is pulling back on its clinic investments.  So, retail healthcare is not without its risks but will continue to grow.

#retailhealthcare #kroger

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Molina Reduces Bright Payment for Medicare Advantage Business

After diligence, Molina Healthcare will cut how much it will pay for Bright Health Group’s California Medicare Advantage plans to $425 million, from $600 million.

Molina did not specify in a news release Monday why it reduced the agreed-upon purchase price by 16.7% from $600 million gross/$510 million net. 

This is more bad news for the insurtech world, which has seen stunning reversals. 

(Article may require a subscription.)

#brighthealth #molina #acquisitions #medicareadvantage #insurtechs

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Blue Shield California CEO On Healthcare Trends

Paul Markovich, President and CEO of Blue Shield California, has some compelling points in an interview with Modern Healthcare.  Markovich admits that the industry has stumbled at points.  He notes that insurers have to do a better job on productivity and that Star scores in Medicare Advantage (MA) have suffered. He thinks there will be some weeding out in the MA world. He says cost pressures will be front and center in the future.

He is focused on the following:

  • Affordability
  • Rethinking delivery.  He unveiled a radical reform of pharmaceutical delivery a few months ago.
  • Technology investments, including digital health

(Article may require a subscription.)

#bsc #healthcare #healthcarereform #medicareadvantage

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California To Further Expand Medicaid To Immigrants

In 2024, immigrants currently on Medi-Cal, the state’s Medicaid program, will get expanded coverage and more could enroll for healthcare as well.  About 700,000 existing enrollees will get expanded coverage.

Enrollment of others could be hampered by fears related to their immigration status and the simultaneous reintroduction of Medicaid redeterminations.

#medicaid #ca #immigrants #coverage #redeterminations

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Medicare Advantage Enrollment Difficult And Needs Reform

Good Health Affairs Forefront blog on the difficult enrollment process that seniors go through for Medicare Advantage.  With the program growing, the blog propose several reforms.  I like the one that de-emphasizes the use of brokers (which may or may not have the best interests of the enrollee at heart) in favor of more unbiased State Health Insurance Assistance Program (SHIP) funding. 

(Article may require a subscription.)

#ship #medicareadvantage #enrollment

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Private Equity Criticized For Role in Health Care

I am as free market as the next guy, but the authors of this Health Affairs Forefront blog pull no punches in their criticism of private equity’s (PE) role in healthcare. It is hard to argue against much of it. The blog describes the hold private equity has on some hospitals and the fallout in communities.  I note, too, the huge role PE plays with physician groups and other providers. It is hard to argue there has not been fallout there, too.  I often cite the fact that doctors owned by hospitals and PE-backed physician groups tend to drive up costs in the system – something we cannot afford. No matter your views on the free-market investment in healthcare, the issue of PE ownership and activities is getting traction on Capitol Hill.

(Article may require a subscription.)

#privateequityfirms #healthcare #hospitals #physicians #providers

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Biden Administration Touts Coverage Expansions

A Health and Human Services (HHS) release and analysis shows the major coverage expansion that has occurred when states take advantage of expanded coverage policies from the federal government.  While I believe that states should have flexibility in the partnership program, the analysis is compelling when you think about the advantages of upfront coverage. HHS Secretary Becerra takes to task the ten states that have not expanded Medicaid and also sent letters urging some states to adopt federal coverage and enrollment strategies. Additional release/analysis here: https://www.hhs.gov/about/news/2023/12/18/new-state-by-state-analysis-on-impact-cms-strategies-for-states-protect-children-youth-medicaid-chip-enrollment.html

#medicaid #chip

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Kaiser Family Foundation Analyzes The Uninsured

Good analysis by the Kaiser Family Foundation (KFF) on the profile of the uninsured.  One interesting statistic:  the uninsured rate is just over 14% on average in states that did not expand Medicaid while it is just 7.5% for those that did. Another stat: a majority of the uninsured are eligible for Medicaid or subsidized Exchange coverage. Last point: KFF shows how being uninsured means you forego care. And we know that adds to costs in the healthcare system overall. As well, KFF published a brief on North Carolina’s Medicaid expansion: https://www.kff.org/policy-watch/an-update-on-aca-medicaid-expansion-what-to-watch-in-north-carolina-and-beyond/

#uninsured #healthcarereform #medicaid #exchanges #aca #obamacare #nc #coverage

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— Marc S. Ryan

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