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June 7, 2024

Oscar Continues Good Performance, Lays Out Strategy Oscar Health reports its first quarterly net profit and hit 1.5 million enrollees in the Exchanges. It plans on investing in individual coverage health reimbursement arrangements (ICHRA) in tandem with its Exchanges offerings as well as re-entering Medicare Advantage. Additional article: https://www.beckerspayer.com/payer/oscar-health-plans-to-double-its-membership-5-things-to-know.html #oscar #exchanges #aca #obamacare #ichra #medicareadvantage https://www.fiercehealthcare.com/payers/oscar-health-growth-ambitions-doubling-its-footprint-planned-ichra-products-launch-and-more The Troubles Of Retail Meets Healthcare Good article on the general struggles with low-reimbursed primary care and additional challenges retailers have had. #retailmeetshealthcare #primarycare #healthcare https://www.fiercehealthcare.com/retail/industry-voices-walmarts-exit-health-centers-reflects-broader-challenges-primary-care Kroger Health Offering GLP-1s Kroger Health joins a growing number of providers driving expensive GLP-1 weight-loss drugs.  This is bound to continue to drive the shortages those with disease states face. (Article may require a subscription.) #kroger #weightlossdrugs #drugpricing https://www.modernhealthcare.com/patient-care/kroger-health-little-clinics-glp-1s-wegovy-zepbound Walgreens Will Not IPO Boots Struggling Walgreens Boots Alliance Inc. is killing an initial public offering for its UK Boots drug chain. It may still be looking for

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June 6, 2024

Medicaid Redeterminations Challenge Plan Finances More coverage of the challenges facing Medicaid managed care with dropping enrollments and rising risk.  I pointed out this possibility in a recent blog here: https://www.healthcarelabyrinth.com/health-plan-economics-part-3-how-falling-medicaid-enrollment-is-impacting-health-plans-and-providers-alike/ (Article may require a subscription.) #medicaid #redeterminations #healthplans managedcare https://www.modernhealthcare.com/insurance/how-medicaid-redeterminations-process-affecting-insurers CVS, Humana Will Lead Cuts To Medicare Advantage A very good article reporting on the current issues facing Medicare Advantage (MA) plans in 2025.  Many plans, especially Humana and CVS Aetna, are expected to pare added benefits back dramatically and could even contract geographies. Hundreds of thousands are expected to have to change plans.  How this all plays out is anyone’s guess, but United could pick up many lives. One interesting note is that margins are eroding but appear to be better with Dual Eligible Special Needs Plans (D-SNPs). In 2021, D-SNPs had margins of 6.4% vs. 2.2% for MA overall. See these blogs I did on the MA

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June 5, 2024

Nursing Home Staffing Mandate Under Fire President Biden’s pro-union nursing staffing mandate is now facing bipartisan opposition in Congress. The rule threatens to create a consolidation in the nursing home industry with small, independent firms selling to big chains because they cannot meet or afford standards. A lawsuit also seeks to challenge Biden’s authority to set such staffing requirements. (Article may require a subscription.) #nursinghomes #healthcare https://www.modernhealthcare.com/providers/cms-nursing-home-staffing-mandate-james-lankford-joe-manchin Antitrust Case Against Sutter Will Again Proceed A U.S. appeals court overturned a 2022 ruling that said Sutter Health did not engage in anticompetitive practices. The case is now reopened due to the fact that the jury did not hear crucial evidence. (Article may require a subscription.) #antitrust #healthcare https://www.modernhealthcare.com/legal/sutter-health-antitrust-lawsuit-verdict-appeal Prominent Senator Lays Blame on HHS For Cyberattacks Senate Finance Chairman Ron Wyden, D-OR, laid blame for the recent Change Healthcare cyberattack on the Department of Health and Human Services (HHS), saying it

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June 4, 2024

Scan Wins Lawsuit Over Star Ratings A federal judge said the Centers for Medicare and Medicaid Services violated the Administrative Procedures Act when it deviated from current regulations to calculate Star scores for 2024.  It was a significant win for Scan and Medicare Advantage (MA) plans in general.  It also could throw 2025 bids and benefit designs as well as 2025 Star measure calculations into flux.  I will have a blog on this on Thursday.  In the meantime, check out my LinkedIn post on the issue here: https://www.linkedin.com/posts/marc-s-ryan-%F0%9F%87%BA%F0%9F%87%A6-1a99529_scan-wins-medicare-advantage-star-ratings-activity-7203759541530808320-CEd6?utm_source=share&utm_medium=member_desktop Additional articles: https://www.beckerspayer.com/payer/scan-beats-cms-in-medicare-advantage-star-ratings-lawsuit.html and https://www.fiercehealthcare.com/payers/judge-sides-scan-health-plan-dispute-cms-over-medicare-advantage-star-ratings and https://www.healthcaredive.com/news/scan-health-plan-medicare-advantage-star-ratings-lawsuit/717976/ (Some articles may require a subscription.) #stars #medicareadvantage #cms https://www.modernhealthcare.com/law-regulation/scan-medicare-advantage-star-ratings-lawsuit-cms Steward Gets Permission On Timeline To Sell Assets Bankrupt Steward Health Care received permission from a bankruptcy judge to sell off its assets on an aggressive timeline.  Federal and state regulators have complained that they may not be able to perform adequate reviews. It is

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