longtermcare

Health Plan Economics Part 4: Other Healthcare Trends And Their Economic Impacts On Plans

This blog is the last of a four-part series on Health Plan Economics. In this series, I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 4 – Other Healthcare Trends And Their Economic Impacts On Plans We are at the end of our four-part series on health plan economics. This last installment is on some healthcare trends we see in the marketplace and how that impacts

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May 3, 2024

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

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May 2, 2024

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

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Health Plan Economics Part 3:  How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike

This blog is part of a four-part series on Health Plan Economics. In this series, I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 3 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike Now that we have covered Medicare Advantage and the Exchanges, let’s move this week to what is happening in Medicaid managed care. Note that I base many of my

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May 1, 2024

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

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April 30, 2024

A Peak At United HealthGroup CEO’s Planned Testimony The United HealthGroup CEO plans on giving detailed testimony this week on Capitol Hill.  His testimony outlines how the cyberattackers got in, which may point to a security flaw in Change Healthcare’s system. United has funneled $6.5 billion to providers impacted so far. Additional article here: https://www.modernhealthcare.com/politics-policy/unitedhealth-andrew-witty-congress-change-healthcare-outage (Some articles may require a subscription.) #changehealthcare #cyberattacks https://www.fiercehealthcare.com/payers/unitedhealth-ceo-witty-set-go-congress-week-heres-look-his-testimony Walmart To Exit Primary Care Market Shocking announcement by Walmart that it will exit the primary care health market, including virtual care, as it has not been profitable.  It will close its Walmart Health locations that have opened.  At one time “retail meets healthcare” was thought to be the future for many retail companies.  While there have been some successes, there are also big failures.  This exit could change many plans to tie healthcare settings to retail ones. In related news, the Walmart co-branded Medicare Advantage

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April 29, 2024

New Study Recommends Health-Related Tiering For Access To GLP-1s A new study recommends a tiering of GLP-1 medication access based on health status. The problem is the price of the drugs are exorbitant compared with other developed countries. And wide access to the drugs is often only available in richer health plans. As such, the reasonable proposal is destined for the ash heap for now. #weightlossdrugs #branddrugmakers #drugpricing https://www.fiercehealthcare.com/regulatory/heres-what-fair-allocation-glp-1s-and-other-weight-loss-drugs-could-look Association Health Plans Will Be Barred Under New Rule The Department of Labor (DOL) is expected to release a final rule that will bar Association Health Plans that were put into effect under the Trump administration. The move was a gimmick to make it look like the GOP had a reasonable alternative to the Affordable Care Act (ACA). It didn’t. Additional article: https://insidehealthpolicy.com/daily-news/admin-rescinds-ahp-rule-coalition-backs-senate-bill (Some articles may require a subscription.) #obamacare #aca https://www.fiercehealthcare.com/payers/dol-set-reverse-trumps-association-health-plan-policy New Class-Action Lawsuit Against MultiPlan And Major Insurers A new

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Health Plan Economics Part 2:  How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances

This blog is part of a four-part series on Health Plan Economics. In this series I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 2 – How The Lapse Of Premium Subsidies Could Hurt The Exchange’s Relatively Stable Finances I hope you are enjoying this blog series on health plan economics. Last week we covered some economics in the news right now for Medicare Advantage. This

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April 26, 2024

FTC Approves Rule Extending Data Privacy To Digital Apps On a 3-2 vote, the Federal Trade Commission (FTC) finalized a rule that extends the scope of its breach notification rule to include personal health information collected by health apps and other technology that are outside the Health Insurance Portability and Accountability Act.  It is a very controversial move and may be beyond the FTC’s authority. Additional article: https://insidehealthpolicy.com/daily-news/ftc-issues-controversial-breach-notification-rule-despite-two-commissioners-dissent #cybersecurity #breaches https://www.fiercehealthcare.com/health-tech/ftc-finalizes-changes-data-privacy-rule-step-scrutiny-digital-health-apps Study Shows Hospital Mergers Raise Price, Little Government Scrutiny Two academic studies say hospital mergers and acquisitions raise price and receive little scrutiny from regulators. That could change with the Biden administration’s new focus. #manda #mergers #acquisitions #hospitals https://www.fiercehealthcare.com/finance/hospital-ma-studies-highlight-higher-prices-tepid-antitrust-intervention Centene Reports Positive Financial News Centene reported reasonably good financial news, beating expectations.  It says its Medicaid dominant business is doing well against forecasts for redetermination enrollment losses and is about 90% through the process. Q1 medical costs were up. 

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April 25, 2024

Cigna Arm To Offer Humira Biosimilar At $0 Cost-Share Finally, we are making some advances on biosimilar adoption.  For awhile, pharmacy benefits managers (PBMs) were teaming up with brand drug makers to stop the uptake of biosimilars through rebate arrangements.  That still happens, but PBMs are seeing the light. Evernorth’s Accredo Specialty Pharmacy will make a Humira biosimilar available to patients with no cost-share. Evernorth is partnering to produce the biosimilar. The biosimilar price is about 85% lower than that of the brand. #biosimilars #drugpricing #brandrugmakers #cigna #evernorth https://www.fiercehealthcare.com/payers/evernorths-accredo-offer-humira-biosimilar-0-out-pocket Kaiser Permanente Reports Major Breach A data breach at Kaiser Foundation Health Plan affected more than 13 million individuals.  It is not a hack or ransomware attack.  It appears the plan’s technology may have inadvertently transmitted personal information to Google, Microsoft Bing and X. (Article may require a subscription.) #cyberattacks #kaiserpermanente #breaches https://www.modernhealthcare.com/cybersecurity/kaiser-permanente-data-breach Mixed News For Molina Healthcare The Molina stock went

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