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March 1, 2024

March 1, 2024 No Comments

Medicare Advantage Will Remain Viable Over The Long Run Good article in Modern Healthcare discussing the fact that, while there will be major bumps in the road, Medicare Advantage (MA) will remain viable and strong.  A great quote from Paul Ginsburg, senior fellow at the University of Southern California Schaeffer Center for Health Policy and Economics. “We’re not talking about any risk to the financial integrity of these companies at all. The Medicare Advantage business is very viable long-term because they’re providing something that more and more Medicare beneficiaries are deciding they want,” Ginsburg said. “Will it be as great for the next few years as it has been? Probably not. It’ll still be very good, though.” This echoes what I said in a January 29, 2024 blog ( https://www.healthcarelabyrinth.com/with-boom-over-will-medicare-advantage-collapse-or-adjust/ ) as well as a February 9 Podcast ( https://www.healthcarelabyrinth.com/9-is-medicare-advantage-exploding-after-its-boom-or-simply-adjusting/ ). As I say, the real victims of terrible policies

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February 29, 2024

February 29, 2024 No Comments

Change Healthcare Cyber Attack Fallout Continues The fallout continues over the cyber attack suffered by Change Healthcare.  United Health Group confirmed the attack was a ransomware one and that the BlackCat cyber gang was behind it. Additional article here:https://www.modernhealthcare.com/cybersecurity/change-healthcare-cyberattack-outage-blackcat-alphv-2024 As well, good overviews of cyber security and the overall event and impacts: https://www.modernhealthcare.com/cybersecurity/change-healthcare-outage-cyberattack-data-breaches-2024 and https://kffhealthnews.org/news/article/unitedhealth-change-healthcare-blackcat-hack-cybersecurity/ Meanwhile, a prominent provider group is calling on the federal government to help them regarding the current Change Healthcare cyber attack, but to also strengthen security overall: https://insidehealthpolicy.com/daily-news/mgma-hhs-help-industry-mitigate-massive-ransomware-attack (Some articles may require a subscription.) #cyberattacks #changehealthcare Link to Article Congress Passes Short-Term Funding Bill The House passed a short-term funding bill by a vote of 320-99 vote and the Senate turned around passing it with a 77-13 vote.  It pushes a government shutdown out to March 8 and March 22. Work continues on appropriation bills.  House Speaker Mike Johnson, R-LA, is under attack by his

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Medicare Advantage Enrollment Growth Continued From January To February

February 29, 2024 No Comments

In my January 22, 2024 Healthcare Labyrinth Blog ( https://www.healthcarelabyrinth.com/great-news-for-insurers-and-medicare-beneficiaries-january-2023-to-january-2024-medicare-advantage-growth-rebounds/ ), I told you about the exciting news of Medicare Advantage’s (MA) continued strong growth (from January 2023 to January 2024) as well as a nice recovery from a bit of a sluggish increase from January 2022 to January 2023. As I always do, I publish short follow-up blogs in the first few months of each year given continuing growth outside of the main enrollment season of October 15 to December 7. The key takeaways from the January 22, 2024 blog were: So what happened with February enrollment? A change over the past few years now allows all members enrolled in an MA plan to change to a different MA plan or go back to traditional Medicare (and also get a standalone Part D plan) between January 1 and March 31 of each year. Previously, an MA member could only

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February 28, 2024

February 28, 2024 No Comments

Stop-Gap Resolution To Keep Government Open Agreed To By Leaders House Speaker Mike Johnson, R-LA, and Senate Majority Leader Chuck Shumer, D-NY, announced that a stop gap continuing resolution has been agreed to by leaders.  This would extend keeping the government open for several weeks. It likely will include a partial Medicare doc fix and restoration of disproportionate hospital cuts.  How the House Freedom caucus will vote is unknown. Additional article here: https://insidehealthpolicy.com/daily-news/lawmakers-announce-partial-approps-deal-including-fda-new-cr (Articles may require a subscription.) #governmentshutdown #crs Link to Article Mississippi Could Expand Medicaid There is some movement in certain deep South states to expand Medicaid under the Affordable Care Act (ACA).  Mississippi could be the first. The House Medicaid Committee on Tuesday advanced the bill and include the highest ACA level.  The measure could extend benefits to about 250,000 people. However, the bill would require at least 20 hours of work with some exceptions. What would

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February 27, 2024

February 27, 2024 No Comments

Justice Department Launches Antitrust Investigation Of UnitedHealth Group With the ongoing cyberattack at Change Healthcare ongoing, The Wall Street Journal reports that the U.S. Department of Justice has an active antitrust investigation going on. It centers on certain relationships between the company’s UnitedHealthcare insurance unit and its Optum health services arm.  Optum is the largest service organization associated with an insurer corporately.  Optum’s tentacles are long and hit almost every area of healthcare. Health plans like Cigna and Elevance Health will be watching as they have dreams of having service units as big as Optum.  These service units generate huge revenue and margins as the business is basically unregulated compared with an insurer (which is confined by the minimum medical loss ratio (MLR) requirements in most products) Additional article here: https://www.reuters.com/business/healthcare-pharmaceuticals/us-launches-antitrust-investigation-into-unitedhealth-wsj-reports-2024-02-27/ #unitedhealthcare #antitrust #optum Link to Article Change Healthcare Cyber Attack Fallout Continues The Change Healthcare cyber attack continues to have

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February 26, 2024

February 26, 2024 No Comments

Not All Is Rosy In Hospital Finance While the hospital industry is recovering overall from the COVID slump, recovery is not universal in the hospital industry. And there are still some bad barometers of financial performance overall. #hospitals Link to Article PBM Reform and Site-Neutral Policy May Not Be Included In Health Bill Due to the major threat of a government shutdown and no consensus yet on the issue, time is running out on passing substantive policy reforms.  Congress is looking at a very skinny health bill and that could mean the death of PBM reform and site-neutral policies this year. A partial or full prospective Medicare doc payment fix will likely still be included. I don’t like the tone and tenor of the PBM reform measures, but would like the site neutral reforms to begin. At the same time, Sen. Chuck Grassley wants a PBM reform vote given the

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2024 Medicare Advantage Compliance And Regulatory Issues

February 26, 2024 No Comments

A number of folks have texted, LinkedIn messaged, or emailed and asked if I would give an overview of some of the major compliance and regulatory issues Medicare Advantage (MA) plans need to be aware of as the 2024 year gets going. Here is my best take on the major issues from a compliance and regulatory standpoint: Audits in full swing I am hearing from health plan friends that MA audits have already begun this year with January notices. As promised by the Centers for Medicare and Medicaid Services (CMS), regular program audits are being supplemented with ad hoc audits concerning the 2024 rule requiring major changes to how MA plans perform prior authorization (PA) and utilization management (UM). In addition to adding the ad hoc audits for those under regular program audit, plans can be noticed for just an ad hoc audit as well.  In general, the new rule

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February 23, 2024

February 23, 2024 No Comments

Major Cyber Attack On United’s Change Healthcare Change Healthcare announced a major cyber attack on its systems this week.  The event shows how vulnerable major healthcare organizations can be.  Change is owned by The United Health Group, granddaddy of insurance and owner of prominent service entity, Optum.  Change rolls up to Optum.  The attack shows how far-reaching a successful penetration could be. Change is a vendor. It has various products and connects to health plans throughout the country.  It also connects to providers and pharmacies throughout the country. Change says the attacker was a nation-state associated cyber security threat actor.  Little else is known about how far-reaching the attack was or the fallout yet. Additional article here: https://www.modernhealthcare.com/cybersecurity/change-healthcare-outage-cyberattack-2024-update (Some articles may require a subscription.) #cyberattacks #healthcare Link to Article Surge In Weight-Loss Drug Costs Troubles States Interesting assessment of the surge in costs for weight-loss drugs in state employee health plans

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February 22, 2024

February 22, 2024 No Comments

New Poll Suggests MA Enrollees Have Issues With Prior Authorization, But Some Use Added Benefits A new poll says Medicare Advantage (MA) enrollees are more likely than those in traditional Medicare fee-for-service (FFS) to experience care delays due to prior authorization, but they do receive supplemental benefits not in the traditional program. While the rates of such use can always be better, a 70% member-use rate is encouraging.  Still, it is indeed time for MA plans to show their value by encouraging the use of all of the added benefits at reasonable rates. Proposed supplemental benefits reporting rules will encourage this trend. Overall, MA plans need to educate members thoroughly on all benefits, lest critics and researchers build a case that there is no added value. The critics continue to argue massive overpayments, which I do not agree with. One point just does not resonate with me. About 12% of

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Part 3: My Courageous Daughter Is Having Brain Surgery!

February 22, 2024 No Comments

This is one of a number of blogs that will appear on my daughter.  I call her Kitty.  She is a wonderfully talented, bright, and empathetic individual in her late ‘20s.  She and I agreed I would write this series to impart how important health coverage is. Not only is her decision to have surgery courageous, but so is her decision to share her journey through me. The principal reason to share the journey is because we both want to explain what many average Americans go through financially when they have major operations and do not have the best insurance or no insurance at all.  My daughter is privileged to come from a well-off family and to have consistent and robust insurance.  This will mean that she will pay a tiny amount for a surgery with a sticker price in the hundreds of thousands of dollars.  But for uninsured and

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