May 29, 2024

Clover Health Unveils Clover Assistant As SaaS Offering

Congratulations to Clover Health by unveiling its Clover Assistant as a SaaS technology offering. Clover Assistant, now marketed as Counterpart Assistant, is available to Medicare Advantage (MA) payers and providers to improve outcomes and close care gaps.

Additional article: https://www.modernhealthcare.com/insurance/clover-health-assistant-medicare-advantage

(Some articles may require a subscription.)

#medicareadvantage #clover #healthplans #providers


New 340B Reform Bill Would Attempt To Return Program To Original Intent

A new House Republican Bill would create major reforms to the 340B program.  Hospitals of course are panning the proposal.  But more and more studies show that hospitals are abusing the program by claiming discounts and then massively marking up drugs anyway.  It is driving costs for inpatient care dramatically for individuals, especially those with cancer. The program was intended to ensure access to those with low incomes.

#340b #hospitals


AI Promotion and Regulation On Capitol Hill Docket

Capitol Hill is looking at creating legislation that will both promote and regulate artificial intelligence, but there is hardly yet a consensus. In the meantime, executive agencies are meeting to craft a regulatory paradigm.

#ai #healthcare


Dollar General Pulls Mobile Health Clinic Initiative

More bad news on retail meets healthcare front.  Dollar General is pulling the plug on its primary care mobile clinic initiative.

(Article may require a subscription.)

#retailmeetshealthcare #primarycare


Warning Signs On Medicaid Front

Both United and Centene have said there are warning signs on the financial front for Medicaid.  While states seemed to pony up additional funds during COVID as enrollment began to drop and risk in the program increased, the insurers are seeing bad warning signs regarding payments vs. risk. Other Medicaid plans are less worried.

See my recent blog and podcast where I raised issues about Medicaid economics turning south: https://www.healthcarelabyrinth.com/health-plan-economics-part-3-how-falling-medicaid-enrollment-is-impacting-health-plans-and-providers-alike/ and https://www.healthcarelabyrinth.com/23-how-falling-medicaid-enrollment-is-impacting-health-plans-and-providers-alike/

Additional article: https://www.beckerspayer.com/payer/unitedhealth-points-to-possible-medicaid-headaches.html and https://insidehealthpolicy.com/daily-news/mcos-say-members-largely-through-redeterminations-aca-enrollment-growing

(Some articles may require a subscription.)

#medicaid #redeterminations #healthplans


Senate Democrats Scrutinizing MultiPlan

Senators Bernie Sanders and Ron Wyden are beginning their close scrutiny over the practices of MultiPlan and major payers who appear to be shifting costs from health plans to insureds.

Additional article: https://www.modernhealthcare.com/politics-policy/legal/bernie-sanders-ron-wyden-multiplan-travis-dalton-briefing

(Some articles may require a subscription.)

#multiplan #healthplans #surprisebilling


Provider-Payer Contract Disputes Are Heating Up

Increasing costs and inflation along with Medicare Advantage prior authorization and claims denials are leading to contentious payer-provider contract negotiations.

In other news, providers want better MA prior authorization data: https://www.beckershospitalreview.com/legal-regulatory-issues/providers-want-better-medicare-advantage-prior-auth-data.html

#healthplans #providers


— Marc S. Ryan

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