UnitedHealth Group Reports Lower Margins
While revenue was up for the year, UnitedHealth Group reported lower annual margins due to high medical expense. Its stock dropped on the news. United is the largest insurer and biggest integrated healthcare company in the nation. Its medical loss ratio (MLR) grew to 87.6% across its lines of business in Q4. Its earnings were still above estimates.
United CEO Andew Witty also said he would ease prior authorizations (PAs) and work with policymakers to overhaul processes. And faced with threats of major regulation of its pharmacy benefits manager (PBM), OptumRx, the CEO also committed to passing through to plans and employer groups 100% of drug manufacturer rebates. Many will be skeptical of the significance of this gesture given PBMs receive many forms of revenue and could easily find ways to maintain current levels of profit streams.
Additional articles: https://www.modernhealthcare.com/insurance/unitedhealth-andrew-witty-prior-authorization and https://www.modernhealthcare.com/insurance/unitedhealth-group-earnings-call-share-price-andrew-witty-medical-costs-revenue and https://www.healthcaredive.com/news/unitedhealth-unh-2024-record-revenue/737477/
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#unitedhealthcare #healthplans #margins
https://www.fiercehealthcare.com/payers/unitedhealth-group-posts-144b-profit-4003b-revenue-2024
Alignment And Clover Report Enrollment Growth in MA
Medicare Advantage (MA) insurers Alignment Healthcare and Clover Health both reported increased membership growth. Alignment’s membership has increased to 209,900 members, a 35% year-over-year increase from the beginning of 2024. Clover Health says it is experiencing similar growth, recording a 27% year-over-year increase following annual enrollment. Clover has more than 100,000 members.
Additional article: https://www.modernhealthcare.com/finance/jpm-2025-alignment-health-medicare-advantage
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#alignmenthealthcare #cloverhealth #medicareadvantage #enrollment
Alignment Sues Over Star Ratings
As I reported, Alignment is suing the Centers for Medicare & Medicaid Services (CMS) over Star rating for 2025. Alignment had filed a thorough lawsuit in which it argues the Tukey outlier is arbitrary, capricious, and bad science. It says the Star program is biased against smaller plans and challenges CAHPS member satisfaction surveys. As well, it says vendors are sloppy and CMS has illegally delegated to them. See my LinkedIn post here for details on CMS lawsuits: https://www.linkedin.com/posts/marc-s-ryan-%F0%9F%87%BA%F0%9F%87%A6-1a99529_cms-stars-medicareadvantage-activity-7285487855009705985-AAOu?utm_source=share&utm_medium=member_desktop . This information will be in a blog next week.
#cms #stars #alignmenthealthcare #medicareadvantage
Biden Touts Accountable Care Reimbursement Models
As he leaves office, President Biden and his Centers for Medicare and Medicaid Services (CMS) announced significant progress toward the agency’s goal of having 100% of traditional Medicare beneficiaries in an accountable care model by 2030. In a Fact Sheet, CSM reported that 14.8 million people or 53.4% of the population is in one of the models as of January 2025. That represents a 4.3% jump from the same time in 2024 — the largest increase to date.
CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/cms-moves-closer-accountable-care-goals-2025-aco-initiatives
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#acos #medicare #cms #vbp
https://insidehealthpolicy.com/daily-news/cms-touts-progress-accountable-care-organizations
Trump Admin Could Be Stymied On Certain Healthcare Reform
Many analysts predict that the Trump administration may have a tough time making some of the changes it would like given the greater power of Congress over the executive branch as well as the disparate views of lawmakers. Some of Robert F. Kennedy Jr.’s and Mehmet Oz’s goals may not be accepted by Congress if they are confirmed. At the same time, analysts are watching antitrust issues, managed care, hospitals, and drugs.
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#oz #kennedy #hhs #cms #trump #healthcare #congress
Budget Office Head Nominee Backs DOGE, Impoundment
White House budget office director nominee Russell Vought backed the efforts of the proposed Department of Government Efficiency (DOGE) commission and impoundment, although he admitted the latter currently is illegal. Impoundment is the executive’s ability to withhold funds that are appropriated by Congress without specific authority. Certain House members are backing a bill to allow impoundment by the president.
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#impoundement #doge #trump
MedPAC Urges Medicare Physician Hike Next Year
The Medicare Payment Advisory Commission (MedPAC) unanimously voted to recommend that Congress tie next year’s physician payment update to the Medicare Economic Index (MEI) minus one percentage point. This would result on average to a 1.3% increase. The proposal would also apply safety-net add-on payments for clinicians providing care to low-income Medicare fee-for-service (FFS) beneficiaries.
The recommendations would boost average FFS payments by 3%, with primary care clinicians seeing a 5.7% increase and other clinicians a 2.5% rise. The proposal would increase federal spending by $2-5 billion in the first year and $10-25 billion over five years.
Lobbyists for doctors continue to seek a way to reverse the 2.8% decrease that just went into effect on January 1 because Congress did not act to reverse the decrease.
(Article may require a subscription.)
#medicare #physicians #rates
Congressional Research Service Offers Ideas To Address Drug Patent Abuse
The Congressional Research Service says Congress could address drug companies’ patent abuses by overhauling the FDA’s Orange Book system, including expanding FDA’s oversight, clarifying eligible patent types, and limiting the 30-month stay that delays generic drug approvals during patent litigation.
(Article may require a subscription.)
#drugpricing #brands #generics #drugpricing #patents #fda
JAMA Study Says MA Enrollees Do Not Use Supplemental Benefits
A new study in JAMA Network Open finds that, while Medicare Advantage (MA) enrollees are more likely to have coverage of vision, dental and hearing services, they are not more likely to use the benefits than those in traditional Medicare.
The study looked at survey data from 2017 through 2021. Just 54% of MA beneficiaries were aware they had dental and vision coverage. Further, for most dental and vision services, traditional Medicare and MA beneficiaries paid similar amounts out of pocket. MA beneficiaries paid 9% less for eyeglasses and 9.3% less for dental visits, the study found.
This adds to concerns that MA supplemental benefits are not well-publicized and utilization is not encouraged. The Centers for Medicare and Medicaid Services (CMS) have put in certain reforms to make enrollees aware of services and to mandate reporting of supplemental benefits as encounters.
#supplementalbenefits #medicareadvantage #medicare
New Medicare Drug Negotiation Lawsuit
Teva Pharmaceuticals is suing the Centers for Medicare & Medicaid Services (CMS) for its implementation of the drug price negotiation program under the Inflation Reduction Act (IRA). At least nine suits exist but thus far drug makers and others have fared poorly in court. The second round of drugs subject to price negotiations will be out in February.
#ira #drugpricing #branddrugmakers #medicare #partd
https://www.fiercehealthcare.com/payers/cms-faces-more-legal-pressure-drug-price-negotiation-program
— Marc S. Ryan
