redeterminations Archives - Page 14 of 16

December 18, 2023

December 18, 2023 No Comments

More “Retail Meets Healthcare” Investments Kroger is piloting value-based primary care clinics like many other retailers. The grocery chain will team up with Better Health Group, a provider network, to build out primary care centers. Kroger in-store clinics will be replaced. There is a senior focus. Walgreens is pulling back on its clinic investments. So, retail healthcare is not without its risks but will continue to grow. #retailhealthcare #kroger Link to Article Molina Reduces Bright Payment for Medicare Advantage Business After diligence, Molina Healthcare will cut how much it will pay for Bright Health Group’s California Medicare Advantage plans to $425 million, from $600 million. Molina did not specify in a news release Monday why it reduced the agreed-upon purchase price by 16.7% from $600 million gross/$510 million net. This is more bad news for the insurtech world, which has seen stunning reversals. (Article may require a subscription.) #brighthealth #molina

December 15, 2023

December 15, 2023 No Comments

Elevance Health and HCSC Looking At Cigna Medicare Reports suggest Elevance Health and Health Care Service Corporation (HCSC) are looking at acquiring Cigna’s Medicare Advantage (MA) lives. Cigna has just over 600,000 Medicare Advantage lives, but has had lower Star ratings than desired. HCSC has just 180,000 MA lives and would love to acquire a bigger footprint. Elevance Health has just over 2 million lives and is trying to grow Medicare as well. In 2021, Elevance acquired MMM’s almost 300,000 lives in Puerto Rico to help with organic growth. #elevancehealth #hcsc #cigna #medicareadvantage #mergers #acquisitions Link to Article BCBSLA Could Be Acquired by Elevance Health At the same time, Elevance Health may acquire BCBSLA after pausing the process earlier this year. This is based on revised regulatory activity. Elevance Health is the largest for-profit owner of Blue Cross and Blue Shield plans, with 14 states nationwide. Additional article here: https://www.modernhealthcare.com/mergers-acquisitions/elevance-health-blue-cross-louisiana-merger-acquisition

December 14, 2023

December 15, 2023 No Comments

Medicare Drug Reform Law Working The Centers for Medicare & Medicaid Services (CMS) says 48 prescription drugs will have lower Part B beneficiary coinsurances in the first quarter of 2024 due to price hikes by drug makers that exceeded allowable increases, with out-of-pocket costs decreasing by $1 to as much as $2,786 per average dose. Over the last four quarters, 64 drugs in total had prices that increased faster than inflation and may be subject to inflation rebates because of the Inflation Reduction Act (IRA). It is hard to argue that the Medicare drug reforms are not working in this case. At the same time, CMS issued a letter to plans and PBMS urging fair reimbursement to pharmacies and urging preparation for 2024 changes under Part D. CMS letter here: https://www.cms.gov/newsroom/fact-sheets/cms-letter-plans-and-pharmacy-benefit-managers . Additional article here: https://www.medpagetoday.com/publichealthpolicy/healthpolicy/107878 . The CMS announcement and backup material here: https://www.cms.gov/newsroom/press-releases/cms-releases-revised-guidance-medicare-prescription-drug-inflation-rebate-program . Similar Health and Human Services release and info here: https://www.hhs.gov/about/news/2023/12/14/new-hhs-actions-and-research-highlight-how-president-bidens-administration-lowering-prescription-drug-costs.html . #drugpricing #ira

December 13, 2023

December 14, 2023 No Comments

CMS Actuary Releases 2022 Healthcare Statistics The CMS Actuary has released its analysis of 2022 national healthcare expenditures. I will write a blog on this in the next week. At the link is the website where the data is uploaded. Centers for Medicare and Medicaid release here: https://www.cms.gov/newsroom/fact-sheets/national-health-expenditures-2022-highlights . In addition, four other articles on the new data: https://www.fiercehealthcare.com/payers/back-normal-health-care-spending-growth-rates-down-pandemic-era-times and https://www.healthaffairs.org/content/forefront/ahead-print-national-health-spending-2022 and https://www.modernhealthcare.com/policy/us-health-care-spending-rose-over-4-trillion-2022 and https://insidehealthpolicy.com/daily-news/cms-2022-health-spending-report-finds-medicaid-drove-federal-spending . Healthcare spending increased 4.1% in 2022 to $4.5 trillion. In 2022, the share of the economy devoted to healthcare spending as a percentage of gross domestic product (GDP) was 17.3 percent. Healthcare’s share of GDP as well as the percentage cost increase both went down in part due to lower government spending on the pandemic from prior years. In addition, Medicaid spending due to enrollment growth was very high. (Some articles may require a subscription.) #healthcare #costs Link to Article ONC Finalizes AI And

December 12, 2023

December 12, 2023 No Comments

A Rare Occurrence For Healthcare Costs In a rare occurrence, medical service costs at hospitals increased 2% in the first three quarters of 2023. This is about the 1.9% that the economy grew. Generally, hospital costs tend to far exceed economic growth and inflation. The report is from Turquoise, a new price transparency startup. The findings also show that costs can vary across regions/markets as well as within markets. #pricetransparency #healthcare Link to Article At The Same Time, Overall Healthcare Costs Rising Advisory firm WTW surveyed 266 insurers across 66 countries and found that 58% are bracing for “higher or significantly higher” healthcare cost increases in the three upcoming years. Global costs increased by 10.7% in 2023, up from a 7.4% increase in 2022. The average cost trend insurers expect is 9.9% next year. #healthcare #healthinsurance Link to Article Excellent Pro Publica Analysis of Waste and Abuse in Medicare Latest estimates

December 11, 2023

December 11, 2023 No Comments

Cigna-Humana Merger Off — For Now The Cigna-Humana merger is reportedly off as the entities could not arrive at financial terms. This leaves Cigna with two big decisions: (1) What smaller deals will they enter into? and (2) Will they sell their Medicare Advantage (MA) business? While MA is a smaller portfolio than many big plans have, if it can improve its Star scores and make additional investments, it could still be lucrative for Cigna. On the other hand, Cigna may be investing most of its efforts in its non-margin-limiting Evernorth services subsidiary. Additional articles: https://www.modernhealthcare.com/mergers-acquisitions/cigna-humana-merger-deal-scrapped-stock-buyback and https://www.healthcaredive.com/news/cigna-humana-deal-falls-through-wall-street-journal/702091/ and https://thehill.com/policy/healthcare/4353008-cigna-ends-plans-to-merge-with-humana-report/ (Some articles may require a subscription.) #healthplans #mergers #acquisitions #cigna #humana Link to Article Bill Would Reform PBMs And Introduce Site-Neutral Payments in Medicare I reported on this last week, but another good article describing a large House bill that would bring some transparency to PBMs and start site-neutral policies

December 8, 2023

December 8, 2023 No Comments

New Poll On Affordable Care Act And Healthcare Issues A new poll shows that the American public favors maintaining the Affordable Care Act and reforming the current healthcare system. My blog Monday will build on my December 7 blog and go deep into this poll. #healthcare #healthcarereform #affordableuniversalaccess #universalaccess Link to Article House May Cancel Physician Medicare Rate Cut A bipartisan group of representatives has introduced a bill in the House that would cancel the 2024 Medicare physician pay cut finalized last month by the Biden administration. Physicians are always on a roller coaster when it comes to rates in Medicare. I think the formula has to be revisited broadly. The House committee bill would only restore 2.5% of the 3.4% cut: https://insidehealthpolicy.com/daily-news/house-ec-bill-would-erase-only-25-physician-fee-cuts-matching-senate (Some articles may require a subscription.) #providers #physicians #rates Link to Article Bipartisan Effort Looking At Healthcare Entity Ownership And Anti-Competitive Behavior Must-read article about efforts by the

December 7, 2023

December 7, 2023 No Comments

United Health Foundation Says Chronic Conditions Rising The United Health Foundation released a study that concludes chronic conditions are rising in the U.S. It also released its annual “America’s Health Rankings” report, which tracks health across the country based on 87 measures and 28 data sources. United finds that persons with multiple chronic conditions has reached their highest levels since they were first tracked. Mental health and diabetes have risen. It also found health condition disparities exist for asthma, COPD, and diabetes. United also found that more people have multiple co-morbidities. United calls for investments in care management as well as health equity. As I note in my book, The Healthcare Labyrinth (available on this website), one of America’s key problems is a lack of investment in health, wellness, and care management. Other developed nations concentrate resources here and have much better outcomes, fewer people with disease states and conditions,

December 6, 2023

December 6, 2023 No Comments

Affordable Care Act 2025 Rule And Ongoing Press On Trump Repeal Remarks While we have already covered the proposed 2025 Exchange rule, this article from Kaiser Health News discusses the rule as well as some of the history of the Affordable Care Act under Trump and later Biden. #aca #obamacare #exchanges #medicaid Link to Article Drug Donations Help The Uninsured and Low Income Great Kaiser Health News article on drug donation programs in states. Helping to save lives and reduce healthcare costs. #drugpricing Link to Article Exchange Enrollment Doing Very Well But Not Picking Up Many Losing Medicaid Coverage Nearly 7.3 million people have selected an Affordable Care Act (ACA) Health Insurance Marketplace plan since the 2024 Marketplace Open Enrollment Period (OEP) opened on November 1. It runs through January 15, 2024. The numbers from the Centers for Medicare and Medicaid Services (CMS) represents activity through December 2 (Week 5)

December 5, 2023

December 5, 2023 No Comments

Is Interest In ACA Truly Fading? The Kaiser Family Foundation (KFF) poll says that the ACA and generally healthcare are fading as issues in the 2024 campaign. The poll was done before Donald Trump’s remarks on the Affordable Care Act (ACA). But let me take a slightly contrarian view here. As the poll notes, about half of the 1,401 people surveyed said the future of the ACA is a key topic. About 70% of Democrats thought so and 32% of Republicans thought so. To me, in a close election, 32% of Republicans thinking the ACA is significant is, well, significant. In a close election, how do you win if one-third of Republicans and a greater percentage of independents care about an issue? KFF poll here: https://www.kff.org/health-reform/press-release/poll-by-a-wide-margin-democratic-voters-now-care-more-about-the-affordable-care-act-than-republican-voters-do-and-voters-trust-democrats-more-than-republicans-to-handle-its-future/ #aca #obamacare #exchanges #medicaid #healthcare #healthinsurance #healthcarereform Link to Article CVS Follows Other Large PBMs in Reforming Reimbursement CVS unveiled Tuesday that it will

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