June 3, 2024

BCBS KC Will Exit Medicare Advantage

Blue Cross and Blue Shield Kansas City has announced it will exit the Medicare Advantage (MA) program.  This shows the challenges created by some poor decisions by the Centers for Medicare and Medicaid Services (CMS).  I had said that many regional plans would pick up lives as major plans offload them due to investor concerns.  Will this be a trend or an exception?

#medicareadvantage #coverage #cms


Cigna Layoffs

Cigna’s Evernorth services arm will lay off some specialty health center employees in favor of a focus on primary care.

(Article may require a subscription.)

#cigna #evernorth #healthcare #layoffs


CVS Searching For Investment Partner For Oak Street

This article speculates a good deal on CVS Health’s search for an investment partner to expand Oak Street, its primary care arm.

(Article may require a subscription.)

#cvshealth #primarycare


Grassley Wants To Understand Ascenion’s Ties To Private Equity

Showing the concerns about private equity’s control on healthcare is bipartisan, Sen. Chuck Grassley, R-IA, is targeting Ascension’s outsourcing of hospitalists to private equity firm. The transaction is subject to a whistleblower complaint.

(Article may require a subscription.)

#privateequityfirms #hospitals #healthcare #antitrust


AmeriLife Sues CMS Over Broker Compensation Changes In MA

AmeriLife, a prominent third-party marketing organization (TPMO), is suing to overturn caps on agents and brokers in the Medicare Advantage (MA) program.  To stop unseemly activities and steerage, the Centers for Medicare and Medicaid Services (CMS) redefined compensation to cover the brokers and TPMOs that are currently receiving huge windfalls from MA plans.  The suit is filed in Texas, which could challenge CMS’ authority to restrict the plan-broker arrangements.  But the rule is a good one.

#marketing #medicareadvantage


GAO Challenges Medicaid Plans On Prior Authorization

Consistent with trends, the Government Accountability Office (GAO) is telling the Centers for Medicare and Medicaid Services (CMS) that it needs to scrutinize and clarify Medicaid managed care plans’ prior authorization of early and periodic screening, diagnosis, and treatment (EPSDT) services, a costly children’s mandate.

(Article may require a subscription.)

#medicaid #managedcare #priorauthorization


The Healthcare Blog Takes Us On A Prescription Journey

Matthew Holt of The Healthcare Blog takes us on a prescription drug journey. I feel for him.  It is a case study in everything wrong with our drug pricing system, the constantly shifting sands within pharmacy benefits managers, and the overall lack of transparency.

#drugpricing #pbms


— Marc S. Ryan

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