epic Archives - Page 44 of 44 - The Healthcare Labyrinth

February 2, 2024

February 2, 2024 No Comments

Cigna Chief Explains Medicare Advantage Exit Cigna CEO David Cordani told investors today that he believes in Medicare Advantage (MA) but it is better for his service business, not his insurance line. In an upbeat investor call, Cordani said that the Medicare line would have required major investments that were not justified based on the size of the portfolio, but that Medicare holds great promise as a service element of its growing Evernorth business. He said Cigna will double down on Evernorth grow. Its report on medical loss ratio was very good as were the financials. Some still question the decision to shed the MA lives. In the current environment for MA, Cordani’s decision may look right. But will it be the right one over the long term? Or, is this a short-term calculation and Cordani will go back after Humana again down the road? Stay tuned. Additional articles here:

February 1, 2024

February 1, 2024 No Comments

MA Issues Trickle Down To Providers And Vendors This article focuses on Medicare Advantage (MA) troubles – rates, utilization, medical expense, and punitive regulatory requirements – and how they impact insurers, value-based-care providers, and vendors. My intel suggests that the traditionally flush global and partial risk funds that insurers have with providers around the country (providers share in profits when they help reduce costs and improve quality) have dried up or are drying up. Providers are already attacking insurers on numerous issues and this development will only make such relationships even worse. Note as well the reference to MA plans emphasizing profitability by reining in market growth and benefits. I say just this in my blog on the topic here: https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ . As well, see my just published blog on the 2025 MA payment proposal: https://www.healthcarelabyrinth.com/2025-rates-for-medicare-advantage-plans-look-tight/ (Article may require a subscription.) #medicareadvantage #vbc #providers Link to Article Scan Group CEO Recommends

January 31, 2024

January 31, 2024 No Comments

Another Flat Year For Medicare Advantage Before Risk Score Trends The Centers for Medicare and Medicaid Services (CMS) announced the 2025 rate hike for Medicare Advantage will be relatively flat. This is similar to what happened in 2024 after big increases in 2022 and 2023. The effective growth rate was up, but the phase-in of a new risk adjustment model basically offsets those gains. The final notice may push these numbers up a bit. If you include risk score trends, MA revenue could increase by about 3.7%. So real revenue should be up, but health plans don’t like thinking of it that way as they think risk score trends tie to increased medical exposure. I include all these articles here but read with caution as many reporters interpret things differently. In the end, this is not the worst news, but it is bad in the face of some major medical

January 30, 2024

January 30, 2024 No Comments

Health Policies To Watch In 2024 The Peterson-Kaiser Family Foundation Health Tracker has a good briefer on expected healthcare policy issues to watch in 2024. Among the many include site-neutral policies, price transparency, drug pricing and trends, PBM reform, drug price differences around the developed world for weight-loss drugs, value-based care and payments, and anti-trust activity. A great primer! #peterson #kff #healthcare #healthcarereform Link to Article Kaiser Family Foundation Publishes Analysis Of Medicare Advantage Enrollment Drivers The Kaiser Family Foundation (KFF) briefer on why Americans are choosing Medicare Advantage (MA) is an important read. I do not agree with everything in it, including references to a recent MedPAC analysis, but MA proponents will have a very good understanding of the threats presented. KFF providers ten reasons. MA is expected to hit at least 60% of beneficiaries by 2030 and that payments to MA are right now about 123% higher, or

January 29, 2024

January 29, 2024 No Comments

Elevance Health Sues CMS Over Medicare Advantage Star Rating Interesting article on Elevance Health’s lawsuit against the Centers for Medicare and Medicaid Services (CMS) on Stars. If this is anything close to true, CMS needs to relook at how it ensure fairness in calculations. How many others may have been impacted? #elevancehealth #stars #medicareadvantage Link to Article Moody’s Says Medicare Advantage Margins On Downturn Interesting analysis by Moody’s that says Medicare Advantage (MA) margins have dropped from 4.9% in 2019 to 3.4% in 2022. Margins fell in commercial too but by a smaller amount. Note that these changes occurred before the latest medical expense upswing, lower 2024 rates, and new prior authorization limitations. Today, I published a blog on the future of MA after some major regulatory changes and a major increase in medical expenses. The boom is over. What will happen? The blog is here: https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ #medicareadvantage #margins #rates

January 26, 2024

January 26, 2024 No Comments

2023 Bankruptcies Highest In Five Years As was reported earlier, another report also shows that bankruptcies were very high in the healthcare arena in 2023. Hospitals, pharmaceutical and senior care companies were on the list. Additional articles here: https://www.modernhealthcare.com/finance/healthcare-bankruptcies-2023-gibbins-advisors and https://www.healthcaredive.com/news/healthcare-bankruptcies-spike-2023-gibbins-advisors/705738/ (Some articles may require a subscription.) #hospitals #healthcare #bankruptcies Link to Article Biden Administration Strikes Again On Mergers The Federal Trade Commission opposes another prominent merger – Novant Health’s purchase of two Community Health Systems hospitals. Additional article here: https://www.healthcaredive.com/news/federal-trade-commission-sues-block-novant-health-community-health-systems-hospital-acquisition/705648/ #mergers #acquisitions #ftc #antitrust Link to Article Drug Maker CEOs To Appear On Capitol Hill A day after some very bad press, Johnson & Johnson CEO Joaquin Duato, Merck CEO Robert Davis and Bristol Myers Squibb CEO Chris Boerner all said they would appear at hearing on drug pricing. Additional article here: https://www.statnews.com/2024/01/26/merck-johnson-johnson-ceos-drug-prices/ (Some articles may require a subscription.) #drugpricing #branddrugmakers Link to Article Medicaid Enrollment Losses Under Redeterminations

January 25, 2024

January 25, 2024 No Comments

Humana Reconfirms Bad News On Utilization In MA After an earlier filing, Humana reconfirmed bad news on the medical expense front. Because it is a predominant Medicare Advantage (MA) insurer, it has seen a major and unexpected rise in utilization, which impacted the company’s 2023 numbers and prospects for 2024 and beyond. Broussard is one of the smartest healthcare leaders out there and he is someone I listen to closely. Given the medical expense rise, rate compression, and regulatory changes (such as the new prior authorization rule), Broussard said he expects similar pricing adjustments from other payers, as the spike in utilization along with ongoing regulatory changes will have major impacts in 2025 and potentially beyond. Broussard says this could very well be industrywide. Humana reduced benefits for 2024 and this could be a continued trend into the future. Humana plans on cutting about $700 million in administrative costs. It

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