340b

CHS Sues MultiPlan Arguing Conspiracy With Health Plans To Fix Commercial Rates Hospital giant Community Health Systems has filed a lawsuit arguing the data analytics firm MultiPlan has conspired with health plans to fix commercial rates in violation of antitrust rules. Visit my blog on the controversy: https://www.healthcarelabyrinth.com/out-of-network-provider-billing-is-yet-another-provider-attack-issue-against-plans/ (Article may require a subscription.) #antitrust #healthplans #providers https://www.modernhealthcare.com/legal/community-health-systems-chs-multiplan-lawsuit Medicare-Medicaid Integration Could Have Pitfalls For Some MA Plans Good article on the evolving mandates to force integration between Medicare and Medicaid.  The Centers for Medicare and Medicaid Services (CMS) has passed several rules that will bring the programs together.  Some Medicare Advantage (MA) plans do not look terribly well-placed to succeed, while others with big Medicaid membership do.  Either way, it will be a huge transformation. (Article may require a subscription.) #snps #specialneedsplans #medicareadvantage https://www.modernhealthcare.com/insurance/medicare-advantage-medicaid-dsnp-centene-molina Medicare PA Bill To Be Reintroduced A bipartisan bill that would levy more prior authorization reform and

Possible Cyberattack At Ascension Catholic hospital system Ascension may have been a victim of a major cyberattack.  It runs 139 hospitals and 40 senior living facilities across the country. Additional article: https://www.modernhealthcare.com/cybersecurity/ascension-possible-data-breach-cyberattack (Some articles may require a subscription.) #cyberattacks https://www.fiercehealthcare.com/providers/systems-clinical-operations-interrupted-ascension-amid-apparent-cybersecurity-event House Ways And Means Passes Telehealth Extension The House Ways and Means Committee passed a two-year extension of telehealth and a five-year addition to the hospital at home waiver. Some pharmacy benefits manager reforms were used as pay-fors. Additional article: https://www.modernhealthcare.com/politics-policy/telehealth-rules-waiver-extension-congress (Some articles may require a subscription.) #telehealth #pbms #hospitalathome https://www.fiercehealthcare.com/regulatory/house-ways-means-committee-reveals-two-year-telehealth-extension-legislation Clover Health Improves Financial Results Clover Health improved its financial performance with a $23 million loss. It also authorized a buyback program.  Clover is one of a few insurtechs doing well, including Alignment, Devoted, and Oscar. #cloverhealth #medicareadvantage https://www.fiercehealthcare.com/payers/clover-health-authorizes-20-million-share-buyback-program Private Equity Healthcare Activity Slowing A new study says private equity investments in healthcare is slowing due to the increased

Telehealth and Hospital At Home Extensions Coming The House Ways and Means Committee may pass a 2-year extension of telehealth as well as a 5-year extension of hospital at home. It would be paid for by some more moderate pharmacy benefits manager (PBM) reforms, including PBM transparency reporting and income based on service fees only. Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/wm-uses-patchwork-pbm-reforms-pay-telehealth-extenders-bill (Some articles may require a subscription.) #pbms #hospitalathome #telehealth #medicare https://www.fiercehealthcare.com/regulatory/house-ways-means-committee-reveals-two-year-telehealth-extension-legislation Oscar Reports First Quarterly Profit And Low MLR Former Aetna CEO and new Oscar CEO Mark Bertolini has shaken up the financial performance of Oscar Health.  For the first time, Oscar has reported a quarterly profit and it projects a positive margin in 2024. A 42% increase in its Exchange enrollment was reported.  It will exit an alliance with Cigna concerning small group plans. It reported a rough 74% Q1 medical loss ratio and expects to come in right around the

Medicare Part A Trust Fund Has A Bit More Life The Medicare Part A Insurance Trust Fund will be solvent for longer than previously projected says the annual Medicare Trustees report. While there are “significant financing issues,” the program will be able to pay all scheduled benefits until 2036, five years longer than the last report. No one can take policy credit (even though the Biden administration will try to do so) for meaningfully adding years to Medicare’s life.  It is all related to technical issues and occurrences. The truth is no party has a coherent policy to stabilize Medicare or entitlements for that matter. Benefit cuts or tax increases will be big if nothing is done. Additional articles: https://www.beckershospitalreview.com/finance/medicares-financial-picture-brightens-slightly.html and https://thehill.com/policy/healthcare/4647137-medicare-fund-economy-solvent-yellen/ #medicare #entitlements #healthcare https://www.fiercehealthcare.com/payers/medicare-hospital-trust-fund-extended-five-years-2036 States Jumping In To Scrutinize Private Equity Investments Where the feds have failed, states are increasingly jumping in to scrutinize private equity firm investments in

Biden Administration Rule Makes DACA Dreamers Eligible For Exchanges Under a new rule, the Centers for Medicare & Medicaid Services (CMS) will make the Deferred Action for Childhood Arrivals (DACA) or dreamers eligible for Exchange enrollment. There are hundreds of thousands of Dreamers and the administration estimates that 100,000 will enroll. Additional articles: https://www.fiercehealthcare.com/regulatory/daca-recipients-eligible-obamacare-under-cms-rule and https://www.modernhealthcare.com/politics-policy/biden-obamacare-access-daca-affordable-care-act-hhs-xavier-becerra (Some articles may require a subscription.) #exchanges #aca #obamacare https://thehill.com/latino/4639985-biden-obamacare-dreamers-affordable-care-act-daca/ Cigna Says Employer Groups Increasing Coverage Of Weight-Loss Drugs In its investor call, Cigna indicated that more and more employer groups are covering weight-loss drugs. The penetration has increased to about 50%. Larger employers tend to cover these high-cost drugs. #weightlossdrugs #drugpricing #branddrugmakers https://www.beckerspayer.com/payer/cigna-more-employers-covering-weight-loss-drugs.html CVS Buys MA Broker Hella Health CVS has acquired a startup Medicare Advantage (MA) broker based in New York City, Hella Health.  The move is thought to help CVS get a better handle on the quality of the upstream enrollment

Alignment Healthcare Reports Growth In Members But Continued Losses Alignment Healthcare will report 165,000 increased enrollment at its Q1 2024 investor call, but a loss from operations of $41.1 million. This still means the insurtech likely is on its way to profitability. #alignmenthealthcare #medicareadvantage https://www.fiercehealthcare.com/payers/alignment-healthcare-raises-membership-guidance-posts-466-million-loss Hospital Margins Dip In March, But Still Positive For Quarter Hospitals’ margins and revenues took a dip in March, but they still had a strong Q1 2024. #hospitals https://www.fiercehealthcare.com/providers/hospital-finance-metrics-stumble-march-remain-strong-through-q1 Medicaid Disenrollments Exceed Forecasts In Eight States A new study gives a good picture of Medicaid disenrollments with the return of redeterminations. The Robert Wood Johnson Foundation-funded Urban Institute report found Medicaid and Children’s Health Insurance Program (CHIP) enrollment declined by 9 million people from April through November 2023. This outcome is expected except that there is some variability between states. Eight states well exceeded forecasted disenrollments: Arkansas, Idaho, Iowa, Montana, New Hampshire, Oklahoma, South Dakota

Stunning Admission By United HealthGroup CEO It was the roasting that was expected, with both sides of the aisle attacking Andrew Witty when he appeared on Capitol Hill.  The United HealthGroup CEO made a stunning admission when he said that Change Healthcare had legacy architecture and technology based largely on internal data centers. It says it is rebuulding all of it on a cloud-based, modern infrastructure. This alone substantiates a lack of business continuity and disaster recovery readiness. In the last few days, United also admitted that simple multi-factor authentication was not in place and that is how the cyber criminals got into the Change platforms. The testimony adds to my theory that when massive consolidation occurs, technology is not modernized and as I call it “spaghetti-ed together.”  The testimony will lead to additional scrutiny of United, a review of vertical integration and consolidation in healthcare, as well as more