June 6, 2024

Medicaid Redeterminations Challenge Plan Finances

More coverage of the challenges facing Medicaid managed care with dropping enrollments and rising risk.  I pointed out this possibility in a recent blog here: https://www.healthcarelabyrinth.com/health-plan-economics-part-3-how-falling-medicaid-enrollment-is-impacting-health-plans-and-providers-alike/

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#medicaid #redeterminations #healthplans managedcare


CVS, Humana Will Lead Cuts To Medicare Advantage

A very good article reporting on the current issues facing Medicare Advantage (MA) plans in 2025.  Many plans, especially Humana and CVS Aetna, are expected to pare added benefits back dramatically and could even contract geographies. Hundreds of thousands are expected to have to change plans.  How this all plays out is anyone’s guess, but United could pick up many lives. One interesting note is that margins are eroding but appear to be better with Dual Eligible Special Needs Plans (D-SNPs). In 2021, D-SNPs had margins of 6.4% vs. 2.2% for MA overall.

See these blogs I did on the MA issues: https://www.healthcarelabyrinth.com/medicare-advantage-will-grow-even-with-a-benefits-reduction/ and https://www.healthcarelabyrinth.com/health-plan-economics-part-1-medicare-advantage-and-new-rumors-of-a-cigna-humana-combination/

#medicareadvantage #enrollment #humana #cvshealth #aetna


Court Rejects FTC Bid To Block Hospital Acquisition

A federal judge blocked a Federal Trade Commission (FTC) attempt to stop Novant Health’s $320 million acquisition of two Community Health Systems hospitals in North Carolina. While I usually applaud the FTC’s scrutiny, the judge’s decision was certainly not unreasonable.

Additional article: https://www.modernhealthcare.com/legal/novant-health-chs-sale-ftc-north-carolina

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#manda #mergers #acquisitions #antitrust #hospitals


Think Tank Says Exchange Premiums Will Increase Without Extension Of Enhanced Subsidies

The left-leaning Center on Budget and Policy Priorities (CBPP) reported in an analysis that premium increases would be high if enhanced premium subsidies are not proactively extended. This is especially true for older enrollees and in states that have high overall premiums. This would have to be done this year to avoid major issues in rate-setting for 2026 due to major bid lead times. I covered this in a recent blog here: https://www.healthcarelabyrinth.com/health-plan-economics-part-2-how-the-lapse-of-premium-subsidies-could-hurt-the-exchanges-relatively-stable-finances/ . At least another one-year extension to debate the issue later is advisable.

In related news, the Kaiser Family Foundation finds that Silver and Gold premiums for a 40-year-old went up 3.3 to 4.5% for popular Silver and Gold plans: https://www.kff.org/affordable-care-act/issue-brief/how-aca-marketplace-premiums-changed-by-county-in-2024/

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#obamacare #exchanges #aca #premiumsubsidies


Excellent Blog On Cost-Containment Through Health Improvement

An excellent blog on The Healthcare Blog that advocates cost-containment in the future through health improvement.  A good read.  I argue in my book, The Healthcare Labyrinth (available at this site), that healthcare reform has three tenets – price reform, affordable universal coverage, and care management. See a recent blog I did on my modest proposal for healthcare reform: https://www.healthcarelabyrinth.com/a-modest-election-year-proposal-for-healthcare-reform/ .

#healthcare #healthcarereform


KFF Finds Higher Rate Of Denials For D-SNPs Than MA Overall

Dual-eligible Special Needs Plans (D-SNPs) had denial rates twice as high as Medicare Advantage (MA) as a whole 12% to 6%. Given the strict audit oversight, the analysis just does not resonate with me.  I would like to understand if there are underlying complexity or social determinant issues that could impact the rates.

KFF analysis: https://www.kff.org/medicare/issue-brief/10-things-to-know-about-medicare-advantage-dual-eligible-special-needs-plans-d-snps/

#priorauthorization #medicareadvantage #snps


— Marc S. Ryan

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