CMS Appealing UnitedHealthcare’s 2025 Stars Win
In very odd timing, the Centers for Medicare and Medicaid Services (CMS) has said it will appeal a federal judge’s order to recalculate UnitedHealthcare’s Medicare Advantage (MA) Star ratings. CMS did not state the grounds for its appeal.
Coming out of a federal judge’s decision siding with United in its suit, CMS did revise UnitedHealthcare’s and Centene’s star rating scores for 2025. UnitedHealthcare received higher ratings in 12 contracts and Centene in seven contracts. Centene’s suit closely mirrored United’s.
Additional article: https://www.modernhealthcare.com/legal/cms-unitedhealth-medicare-advantage-star-ratings-appeal
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#cms #stars #medicareadvantage
https://www.fiercehealthcare.com/payers/cms-will-appeal-unitedhealthcares-ma-star-ratings-court-win
Hospitals Had More Downgrades Than Upgrades in 2024
Credit downgrades for nonprofit hospitals outpaced upgrades in 2024, despite generally better financial performance in the industry overall. Moody’s, S&P, and Fitch collectively issued 95 downgrades and 37 upgrades in 2024, as opposed to 116 and 33 in 2023.
Healthcare providers plan on another year where maximizing efficiency is key or they could see their financial advances reverse. Containing costs, especially on pharmacy and labor, is critical. They will also explore strategic growth opportunities.
Additional article: https://www.healthcaredive.com/news/providers-target-efficiency-supply-chain-resilience-2025/737387/
#hospitals #providers #healthcare #margins
How Serious Is The GOP On Medicaid Cuts?
Interesting article on how serious the GOP is on Medicaid cuts. Some healthcare advocates are very worried given the extensive cuts found in lists created by various GOP-controlled committees. Trillions in cuts have been assembled and the biggest share comes from healthcare, largely because spending is almost $2 trillion between Medicare and Medicaid each year. With Trump’s remarks about protecting Medicare, greater cuts could come from Medicaid.
Among the most extensive Medicaid cuts would be defunding the Medicaid expansion and transforming the current entitlement in Medicaid. How far the cuts go could be dictated by the tight vote margins in each house for Republicans as well as more moderate members who are concerned about the healthcare safety net and the impact on community providers.
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#medicaid #healthcare #congress #doge
https://www.modernhealthcare.com/politics-policy/medicaid-cuts-gop-reconciliation-bill-budget
Providers On The Offensive Against Plans On Claims And Authorizations
Healthcare providers are back on the offensive in 2025, arguing insurers are inventing new ways to deny or delay services or claims and cite new initiatives at a number of insurers. Nearly one in five patients had a claim denied within the previous year. Prior authorization denials have become more common over the past five years, 74% of physicians reported in an American Medical Association survey last June.
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#providers #healthplans #claimsdenials #priorauthorization
https://www.modernhealthcare.com/insurance/claims-denials-review-unitedhealth-bcbs-mi-elevance
Warren Challenges Kennedy With 175 Questions
Sen. Elizabeth Warren, D-MA, has fired off 175 questions to Health and Human Services Secretary nominee Robert F. Kennedy Jr. in anticipation of his confirmation hearing next week. They include questions on his vaccine stance, reproductive health, pharmacy benefits manager (PBM) reform, and Medicare drug price negotiations.
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#rfkjr #hhs #warren #healthcare
Could Medicare Drug Price Negotiations Foster Innovation?
A Health Affairs Forefront blog makes the case that Medicare drug price negotiations could actually foster innovation. The authors argue “promoting transparency in pricing, tying pricing to clinical value, and leveraging competition, the IRA not only introduces downward price pressure but may also foster a more innovation-driven environment where companies are rewarded for developing therapies that offer real, tangible benefits to patients.” They say it could move dollars from marketing to innovation and end evergreening of drugs by making cosmetic changes to successor formulas.
Another article argues that the Trump administration should protect the most valuable drug innovation, while also cutting spending on low-value treatments.
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https://www.statnews.com/2025/01/22/medicare-drug-price-negotiations-floor-cms/
#drugpricing #ira #branddrugmakers
— Marc S. Ryan