January 8, 2024

Aetna Turnaround On Stars And Enrollment Is Amazing

At the JP Morgan conference, CVS President and CEO Karen Lynch was taking a well-deserved victory lap.  With all that is going on at CVS, the Aetna turnaround on enrollment and Stars in Medicare Advantage (MA) is amazing.  It is no small feat given competitiveness in the MA world and the major changes in Star for 2024. 

#cvsaetna #cvshealth #aetna #medicareadvantage

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Clover Touting Clover Assistant

Clover Health also deserves credit for its work creating the Clover Assistant.  It has been shown to promote better outcomes, especially in the tough pharmacy adherence area. With prior authorization to take a back seat, data analytics and member and provider engagement are key to reducing and controlling medical expense at health plans.

#clover #dataanalytics #engagement #caremanagement

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Alignment Healthcare Bullish On Membership And Positive Margin

Alignment Healthcare John Kao expects major enrollment growth in 2024 and says the insurtech will report a positive margin. In an SEC filing, Alignment says that its Medicare Advantage (MA) membership rose 44% to 155,000 by year-end 2023. It expects 164,000 in 2024. It is benefiting from converting a high percentage of its membership from other plans. Insurtechs have had a mixed record over the past few years, but there is some signs of promise here.

#alignmenthealthcare #medicareadvantage #insurtechs

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Uber Expands Healthcare Investments

Uber has announced a partnership with Socially Determined to expand its healthcare commitment and investments. Uber will leverage the social risk analytics technology at Socially Determined and together the firms will help providers and payers identify vulnerable Medicaid, Medicare Advantage, and commercially insured beneficiaries with critical social determinant barriers. This ties to Uber’s efforts to enter the food delivery, transportation, and prescription drug delivery businesses.

Additional article here: https://www.modernhealthcare.com/digital-health/uber-health-socially-determined-integrate-grocery-delivery-transportation

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#uber #sdoh #socialdeterminants #healthcare #socialneeds

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Poor Performance Means Terminations For MA Players

The Centers for Medicare and Medicaid Services (CMS) rule that allows termination if contracts continually underperform in Medicare Advantage (MA) has been in force for several years and continues to hit plans big and small.  It is a signal that all is not well in the world of Star performance.

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#medicareadvantage #stars

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Kelly Munson Becomes Head Of AmeriHealth Caritas

WellCare and Aetna Medicaid leader Kelly Munson will become the new leader of AmeriHealth Caritas (AHC). AHC is big in Medicaid and is building Medicare Advantage.  It also owns a PBM, PerformRx.

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#ahc #medicaid #medicareadvantage

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CVS Invests In In-Home Primary Care

Another coup for CVS as its capital arm invests in in-home senior primary care firm WellBe. A strategic partnership could be formed.  The investment goes well with its other primary care assets.  Could a takeover be in the works for down the road?

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#retailmeetshealthcare #cvshealth #primarycare

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Digital Health Funding Low In 2023

Digital health funding had its worst year since 2019, according to research and digital health venture firm Rock Health. Venture funding of digital health companies dropped from $15.3 billion in 2022 to $10.7 billion in 2023. This is a combination of economic issues, high interest rates, and a move toward conservatism on investors’ parts.  This is probably driven by some high-profile blowups of late.

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Amazon Launches Major Health Initiative That Will Have Multiple Partners

More “retail meets healthcare” as Amazon unveils a new approach to weight management, diabetes, and other disease states and conditions.  When users search Amazon for health-related devices, they will be offered connections to vendors with chronic condition management services.  The first vendor is Omada Health, which has access to over 20 million covered lives through its employer and health plan contracts.  It has one million members enrolled.

Amazon has struggled to gain traction with health investments and has had mixed results. But it appears determined to continue.  Overall, a smart move that should pay off over time.

#retailmeetshealthcare #digitalhealth #amazon

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Brand New HHS Competition Czar Position Created and Named

A major development in the anti-trust world: the Department of Health and Human Services (HHS) has appointed a new chief competition officer.  The officer will work directly with the Federal Trade Commission (FTC) and the Department of Justice (DOJ) to evaluate proposed healthcare mergers. This ties directly to the new guidance and executive order of the Biden administration on mergers and acquisitions. Payers and providers should expect major scrutiny in 2024.

Additional article here: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/sanders-tapped-fill-new-hhs-chief-competition-officer-position . HHS press release: https://www.hhs.gov/about/news/2024/01/08/secretary-becerra-names-chief-competition-officer-to-help-identify-areas-to-promote-competition-in-health-care.html

(Some articles may require a subscription.)

#mergers #acquisitions #antitrust #ftc #doj #hhs

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Sanders, Other Democrats Investigating Asthma Inhalers

Senate HELP Committee Chairman Bernie Sanders, I-VT, and other Democrats are calling for an investigation into the prices of asthma inhalers and have asked leading brand drug makers for information.  This will likely lead to committee appearances and a full hearing.  Some of the brand drug makers are losing market share as generics for some brands are being introduced. But this is not the case across the board. 

#drugpricing #sanders

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Seeming Breakthrough On Budget Deal

The four congressional leaders and President Biden have agreed to a 2024 spending structure that could set in motion bills to fund the government through September 30, 2024.  The overall spending would be slightly below the debt limit levels that doomed former Speaker Kevin McCarthy and led to his ouster by the Republican rightist faction. 

Democrats in both chambers appear to reluctantly support the deal, recognizing the politics of Washington right now.  Some rightist Republicans, from the wing which new Speaker Johnson hails, are criticizing the deal, but it is unlikely to go down if Democrats remain on board. This means the likelihood of a shutdown will drop significantly and the government will stay open.

But will rightists now go after Johnson, whose spending changes seem de minimis (a rounding error) compared with the debt limit levels. I have to believe they are not that foolish and that McCarthy might have been in the wrong place at the wrong time.

#governmentshutdown #biden #johnson #crs

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— Marc S. Ryan

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