June 7, 2024

Oscar Continues Good Performance, Lays Out Strategy

Oscar Health reports its first quarterly net profit and hit 1.5 million enrollees in the Exchanges. It plans on investing in individual coverage health reimbursement arrangements (ICHRA) in tandem with its Exchanges offerings as well as re-entering Medicare Advantage.

Additional article: https://www.beckerspayer.com/payer/oscar-health-plans-to-double-its-membership-5-things-to-know.html

#oscar #exchanges #aca #obamacare #ichra #medicareadvantage


The Troubles Of Retail Meets Healthcare

Good article on the general struggles with low-reimbursed primary care and additional challenges retailers have had.

#retailmeetshealthcare #primarycare #healthcare


Kroger Health Offering GLP-1s

Kroger Health joins a growing number of providers driving expensive GLP-1 weight-loss drugs.  This is bound to continue to drive the shortages those with disease states face.

(Article may require a subscription.)

#kroger #weightlossdrugs #drugpricing


Walgreens Will Not IPO Boots

Struggling Walgreens Boots Alliance Inc. is killing an initial public offering for its UK Boots drug chain. It may still be looking for a buyer.

(Article may require a subscription.)



Federal Court Rejects Dismissal Of Humana Case On Risk Adjustment Audits

A federal court in Texas has rejected a bid by the federal government to get a Humana case challenging the risk adjustment data validation (RADV) audit rule dismissed.  Humana’s case has validity and at least some of the rule could be overturned.

(Article may require a subscription.)

#humana #radv #riskadjustment #medicareadvantage


Senate Democrats Want Mental Health Parity Rule Finalized

A group of Senate Democrats want three federal departments to finalize a mental health parity rule that has been open for almost a year.

(Article may require a subscription.)

#mentalhealth #healthcare


Medicaid Managed Care In Flux In Texas

Texas officials so far have rejected attempts by insurers losing state Medicaid and children’s health contracts to stay in the program after losing in a procurement process. The massive changes in the program would mean shifting many from one plan to another. An executive commissioner could still weigh in.

#tx #medicaid #chip #managedcare


House Committee To Review Value Of Medicare And Medicaid Pilots

House Energy & Commerce Republicans will hold a hearing on the success of the CMS Innovation Center’s demonstrations in Medicare and Medicaid.  Like the GOP, I am skeptical of the savings in these pilots as well as the administrative costs. Reform is needed as the traditional programs will be around, but there are far too many pilots, which cause great confusion for providers. The quality and cost-savings outcomes seem dubious.

(Article may require a subscription.)

#medicare #medicaid #healthcarereform


Humana Seals Response To Amended Complaint Due To HIPAA

In a court action challenging Humana’s use of AI in claims decision-making, the insurance giant has filed a sealed response to the complaint and cites the health insurance privacy law. The move is meant to ensure no public disclosure of sensitive information.

(Article may require a subscription.)

#claimsdenials #ai #healthcare #medicareadvantage #healthplans


CBO and Other Agencies Discuss Cost And Benefit Of Permanent Enhanced Subsidies

The Congressional Budget Office (CBO) has come out with estimates about costs of extending the temporary enhanced premium subsidies in the Exchange that are set to expire at the end of 2025.  The CBO says primary deficits from 2025–2034 would increase by $335 billion if the enhancement are permanently enacted. Including interest on debt pushes the cost up to $383 billion in that period. However, CBO says that from 2026 to 2034 an average of 3.8 million more people would have health insurance. In rough measure, that is about $10,000 per person per year. While that seems high, I think it would be cost-effective. Imagine what one emergency room or inpatient stay would cost for each person each year? 

#aca #obamacare #exchanges #coverage


— Marc S. Ryan

Leave a Reply

Your email address will not be published. Required fields are marked *

Available Now