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
https://www.modernhealthcare.com/insurance/cigna-evernorth-care-layoffs-closings
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
https://www.modernhealthcare.com/providers/cvs-health-oak-street-private-equity-investment
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
