alignmenthealthcare

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January 9, 2024

NY Wins Medicaid Waiver Approval New York received an 1115 Medicaid waiver approval from the Centers for Medicare and Medicaid Services (CMS) covering a myriad of innovations, including recruitment and retention of Medicaid providers, eligibility to bill social needs spending, primary care investments, behavioral health investments, and health equity pilots. CMS press release here: https://www.cms.gov/newsroom/press-releases/cms-approves-new-yorks-groundbreaking-section-1115-demonstration-amendment-improve-primary-care #medicaid #cms #waivers #socialneeds #healthequity Link to Article Both Cigna And CVS Say They Are Ready For Changes in PBM World Both Cigna and CVS, owners of two of the three largest traditional Pharmacy Benefits Managers (PBMs) say they are ready for the transformation in the world of PBMS that may be coming. Cigna went as far as to say they welcome unbundling, where plans may hire multiple entities to service them in a transparent way. See my Blog on PBM Transparency from December 14 for the emerging changes in the PBM industry: https://www.healthcarelabyrinth.com/pbm-transparency-and-reform-is-a-big-trend-in-the-american-healthcare-system/ #pbms

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January 8, 2024

Aetna Turnaround On Stars And Enrollment Is Amazing At the JP Morgan conference, CVS President and CEO Karen Lynch was taking a well-deserved victory lap.  With all that is going on at CVS, the Aetna turnaround on enrollment and Stars in Medicare Advantage (MA) is amazing.  It is no small feat given competitiveness in the MA world and the major changes in Star for 2024.  #cvsaetna #cvshealth #aetna #medicareadvantage Link to Article Clover Touting Clover Assistant Clover Health also deserves credit for its work creating the Clover Assistant.  It has been shown to promote better outcomes, especially in the tough pharmacy adherence area. With prior authorization to take a back seat, data analytics and member and provider engagement are key to reducing and controlling medical expense at health plans. #clover #dataanalytics #engagement #caremanagement Link to Article Alignment Healthcare Bullish On Membership And Positive Margin Alignment Healthcare John Kao expects major

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