February 5, 2024

Spectacular But Not Unexpected Fall Of Cano Health

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/

(Some articles may require a subscription.)

#medicareadvantage #humana #providers

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Humana Reacts To CMS MA Rate Announcement

Humana reacted publicly today to last week’s rate announcement. Despite the reduction being larger than expected, it reconfirmed its more recent guidance on earnings. The final rates could be higher.

See my recent blogs on the subject: https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ and https://www.healthcarelabyrinth.com/with-medical-expense-rising-what-are-health-plans-to-do/

Additional article here: https://www.healthcaredive.com/news/humana-medicare-advantage-rate-notice-2025/706525/

#humana #medicareadvantage #rates

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Rural Providers Optimistic About 2024

Despite major challenges, a survey of rural providers suggest they are upbeat about 2024.


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Cigna Asks That Claims Suit Be Dismissed

The Cigna Group asked that a class-action lawsuit be dismissed.  The suit alleges that the insurer uses a computer algorithm to automatically reject hundreds of thousands of patient claims. 

#cigna #claimsdenials

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Kaiser Family Foundation Finds Most Seniors Have Low Income, Little Savings

A new Kaiser Family Foundation (KFF) finds that seniors have low incomes and modest savings, which poses a major risk to their economic well-being.  I always say that Medicare Advantage (MA) is the single greatest social services program for seniors as it helps protect them from bankruptcy by filling in gaps in the traditional Medicare program and covering a great deal of the high 20% cost-sharing in fee-for-service (FFS).  The Centers for Medicare and Medicaid Services (CMS) and Capitol Hill seem intent on destroying the program with recent regulations and proposals.

Press release here: https://www.kff.org/medicare/press-release/low-incomes-little-savings-many-medicare-beneficiaries-have-modest-financial-resources-to-draw-upon-in-retirement/

#medicareadvantage #kff #coverage

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Bill Would Further Protect Small Molecule Drugs

House Energy & Commerce health subcommittee chair Brett Guthrie (R-KY) wants to further protect small molecule drugs in the Medicare price negotiations of the Inflation Reduction Act (IRA). The bill would extend out the timeframe before the price negotiations would kick in.

(Article may require a subscription.)

#ira #drugpricing

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Good Article On Two-Midnight Rule Under New CMS Rule

Good STAT article on the impact of the new Centers for Medicare and Medicaid Services (CMS) prior authorization rule on MA plans and how it is a boon to providers.  The two-midnight rule impacts MA plans’ ability to have observation days for certain potential admissions.  The traditional program rules simply bow to the views of providers, which is wasteful and inappropriate. 

See my blogs on the subject here: https://www.healthcarelabyrinth.com/cms-medicare-advantage-utilization-management-rule-is-a-terrible-precedent/ and https://www.healthcarelabyrinth.com/medicare-advantage-will-have-huge-challenges-ahead/ and https://www.healthcarelabyrinth.com/major-changes-in-medicare-advantage-oversight/

(Article may require a subscription.)

#priorauthorization #medicareadvanatge #healthplans #managedcare #providers #insurers

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Health Affairs Blog Suggests March-In Rights On Drug Patents Mean Little

A good Health Affairs Forefront blog on march-in rights and how the Biden initiative could amount to little.  The blog suggests a better way to get traction is to have Medicare drug prices negotiated for drugs with significant government investment negotiated after five years, not thirteen years.  An excellent point.

Another article from Health Affairs Forefront on valuing drugs accurately: https://www.healthaffairs.org/content/forefront/we-valuing-prescription-drugs-appropriately

(Articles may require a subscription.)

#drugpricing #ira

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More Layoffs At Health Insurers

Medica is laying off a significant number of personnel.  They are not the first in 2024 and will not be the last.  Insurers are seeing a return of normal utilization, higher medical expense, and significant regulatory pressures.

(Article may require a subscription.)

#healthcare #insurers #healthplans

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Healthcare Job Growth Hits Three Decade High In 2023

Post pandemic, the healthcare industry hit a three decade employment high by adding more than 650,000 jobs in 2023.


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Senate Working On Bipartisan 340B Reform Bill

The Senate wants to clarify the intent of the 340B program in a number of ways, including preventing drug companies from imposing contract pharmacy restrictions, reining in offsite use of 340B discounts unless full integration with the sponsor entity exists, and clarifying what a 340B patient is. Reforms are long overdue in the abused program, which grants drug discounts to healthcare entities with little oversight.  Consequently, we do not know if the program is granting access to low-income Americans or not.  We do know that some hospitals have used the discounts to simply inflate margins. The bill will not be perfect but anything will help. A use fee would also be assessed to help with oversight.

(Article may require a subscription.)

#340b #drugpricing #healthcare #hospitals #providers

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GA And FL Suing Federal Government On Regulatory Issues

Two southern states are suing the federal government over Medicaid and state children’s insurance issues. FL believes it should be able to remove children from rolls under continuous eligibility if families do not pay premiums.  GA wants the Centers for Medicare and Medicaid Services (CMS) to honor the parameters of the original waiver.  The Trump CMS endorsed the waiver (which had both coverage expansion and work requirements), while the Biden CMS sought to claw the waiver back and delay implementation.

My thoughts:  I have my strong views on the need to have consistent coverage, especially for children.  But states should have the right to set certain rules, especially if they are chipping in significant amounts of the funding.

(Article may require a subscription.)

#ga #fl #cms #medicaid #chip

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— Marc S. Ryan

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