February 2, 2024

Cigna Chief Explains Medicare Advantage Exit

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/

(Some articles may require a subscription.)

#medicareadvantage #cigna #humana

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Hospital Lobby Wants Star Measure Tied To PA Reporting

The Federation of American Hospitals (FAH) wants a quality measure in the Medicare Advantage (MA) Star ratings program that would require health plans to report certain prior authorization denial rates. Mentioned in the article was a badly flawed report on prior authorizations and claims denials from the Health and Human Services Office of Inspector General (HHS OIG).

#hospitals #medicareadvantage #claimsdenials #priorauthorization

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Some Hope For Medicaid Expansion In the South

A good article from Politico on activities and changing opinions on Medicaid expansion in Alabama, Georgia and Mississippi.  As well, advocates ate pushing to bring Medicaid expansion to the ballot in Florida.  Just ten states have not yet expanded Medicaid under the Affordable Care Act (ACA).

Article on Florida here: https://thehill.com/policy/healthcare/4445401-florida-medicaid-expansion-advocates-launch-ballot-effort-2026/

#medicaid #aca #obamacare #coverage

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Healthcare CFOs Express Greater But Cautious Optimism for 2024

Good round up on financial prospects throughout healthcare in this article. It covers profitability, recovery, M and A, and AI.

#healthcare #2024 #margins #ai #manda

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Good Example Of Expanding VBC Between Payers And Providers

FL Blue is expanding its value-based-care provider relations.  While not a fully advanced model, the arrangement pushes down that road, focusing on Medicare and elderly populations.

#medicareadvantage #flblue #vbc

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Screenings Have Not Returned To Pre-Pandemic Levels, Especially for Minorities

A new study in JAMA Forum finds that screenings have not returned to pre-pandemic levels and this is a big challenge for racial and ethnic minorities.


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— Marc S. Ryan

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