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July 2, 2024

KFF Analysis Says MA Still Has Highest Margins

A Kaiser Family Foundation (KFF) analysis says that the highest gross margins were found in Medicare Advantage (MA) in 2023. At the end of 2023, gross margins per enrollee in MA were $1,982 on average compared to $1,048 in the individual market. Medicaid was the lowest at $753. Group plans fell in the middle at $910.

Despite some of the troubles health plan are having with MA right now, the data proves MA is still a good place to be, with high revenues per enrollee and the ability to reduce spending to generate good margins.

KFF Analysis: https://www.kff.org/medicare/issue-brief/health-insurer-financial-performance/

#medicareadvantage #healthplans

https://www.fiercehealthcare.com/payers/kff-insurance-market-had-highest-gross-margins-last-year

Five States Extend Medicaid To Incarcerated Individuals

Residents in Illinois, Kentucky, Oregon, Utah and Vermont will receive Medicaid or children’s health insurance coverage prior to release to minimize gaps in insurance coverage.

#medicaid #chip #managedcare #coverage #healthcare #healthcarereform

https://www.fiercehealthcare.com/payers/hhs-approves-incarceration-transition-coverage-five-states

Biden And Sanders Say GLP-1 Drug Maker Ripping Americans Off

In an op-ed with President Biden, Sen. Bernie Sanders, I-VT, accused Danish firm Novo Nordisk of ripping off Americans by charging exorbitant prices for its weight-loss drugs. In addition they argue that putting everyone on who could benefit from such drugs would bankrupt our government programs. The drug firm had a contorted response, but data indicates that prices in the U.S. even net of rebates are well more than other developed countries. Drug makers focus on criticizing pharmacy benefits managers (PBMs).

Additional article: https://www.beckershospitalreview.com/glp-1s/biden-sanders-to-ozempic-maker-stop-ripping-off-americans.html

#weightlossdrugs #drugpricing #branddrugmakers

https://thehill.com/policy/healthcare/4751652-drug-pricing-biden-sanders

7 New Plans Snag 5-Star MA Ratings

The Centers for Medicare and Medicaid Services (CMS) published recalculated Star scores for 2024 and seven additional plans snagged coveted 5-Star ratings. 

#cms #stars #medicareadvantage

https://www.beckerspayer.com/payer/7-medicare-advantage-plans-snag-5-star-ratings-after-cms-redo.html

Humana Could Buy Walmart Health Clinics

A published report says that Humana is among potential buyers of Walmart Health’s 51 clinics based near retail spaces, most of which were in Texas and Florida. Humana currently owns 250 CenterWell primary care clinics. On one hand, many would ask why could Humana make a go of it if Walmart couldn’t. The answer lies in Humana’s success in integrating its owned providers into the Humana business with risk arrangements.  The issue with Walmart was not the location near retail sites, but a lack of understanding of the primary care market.

#humana #walmart #retailmeetshealthcare #primarycare

https://www.beckerspayer.com/m-and-a/humana-among-potential-buyers-of-walmart-clinics-report.html

KFF Profile Of Part D Coverage In 2024

A good analysis by the Kaiser Family Foundation on Part D coverage in 2024.  KFF reports that well over half (57%) of Part D enrollees in 2024 are in Medicare Advantage (MA) drug plans rather than free-standing Part D (PDP) plans.  In another analysis, it finds that a majority of states offer MA to their state retirees, with 13 offering MA exclusively.  Employer group waiver plans are quickly becoming a cost-effective way for employers to continue to offer retiree benefits.

Additional article: https://www.kff.org/medicare/issue-brief/in-2024-a-majority-of-states-offer-medicare-advantage-plans-to-their-state-retirees-with-13-offering-medicare-advantage-exclusively/

#medicareadvantage #egwp #partd #pdp

Https://www.kff.org/medicare/issue-brief/key-facts-about-medicare-part-d-enrollment-premiums-and-cost-sharing-in-2024/

More Analysis Of The Impact On Repeal Of Chevron Deference

Continuing analysis over the impact of the Supreme Court’s decision to do away with the Chevron deference.  Parties continue to extol the virtue of Chevron and worry about delays and conflicting court decisions with the precedent’s termination. They predict major impact on healthcare policy.  I have a blog coming out on Thursday that covers this issue in-depth. In other news, some are now predicting that major healthcare reform measures involving providers, insurers, pharmacy benefit managers (PBMs) and AI technology could now dim due to uncertainty due to the decision. Congress may not have the time to dig into details right now.

Additional articles: https://www.modernhealthcare.com/policy/chevron-deference-ruling-healthcare-regulation-hhs-cms and https://www.modernhealthcare.com/politics-policy/chevron-ruling-congress-telehealth-ai-pbm-bills

(Some articles may require a subscription.)

#chevrondeference #healthcare #healthcarereform #regulations #cms #hhs

https://www.kff.org/private-insurance/issue-brief/supreme-court-decision-limiting-the-authority-of-federal-agencies-could-have-far-reaching-impacts-for-health-policy/

— Marc S. Ryan

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