Health Plan Weekly

Anthem Blames Rising MLR In 4Q on Flu Season, HIF

Anthem, Inc. continued to struggle with a higher-than-anticipated medical loss ratio (MLR) during the last quarter of 2019, and its earnings per share (EPS) guidance for 2020 fell short of what equities analysts wer...
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© 2024 MMIT

Some Insurers Balk, but Analysts Are Not Overly Concerned by Medicaid Block Grant Guidance

On Jan. 30, CMS released its long-awaited “Dear State Medicaid Director” letter containing detailed guidance that paves the way for states to receive capped federal Medicaid funding in exchange for more flexibil...
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© 2024 MMIT

Affordable Care Act Reduces Racial Disparities in Health Care Coverage

The Affordable Care Act (ACA) has significantly reduced racial disparities in access to health care since 2014, according to a recent analysis by The Commonwealth Fund. The gap between uninsured rates for black adul...
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© 2024 MMIT

News Briefs

✦ On Jan. 27, the Supreme Court lifted an injunction blocking implementation of a Dept. of Homeland Security rule that makes obtaining a green card or entering the United States more difficult for legal immigrants...
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© 2024 MMIT

Payers Bet on Telemedicine to Solve Primary Care Challenges

Access to primary care is one of the crucial challenges facing the health care system. As payers and providers try to rein in specialist and acute care overuse, preventive medicine and patient education — central ...
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© 2024 MMIT

Nebraska Applies for Two-Tiered Medicaid Expansion Waiver

With Medicaid demonstration programs that include work requirements struck down in three states, it’s become increasingly clear that such waivers may not survive legal scrutiny. So Nebraska, which last month submi...
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CVS Health Proposes Four Ways To Cope With Gene Therapy Cost

As payers brace themselves for accelerated approvals of cell and gene therapies, they are searching for ways to manage those costs. In an effort to keep pace with competitors, CVS Health Corp. entered the fray, sket...
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© 2024 MMIT

Supreme Court Declines Expedited Review of ACA Lawsuit

In a blow to the managed care industry, the Supreme Court chose to delay intervening in Texas v. United States, the Republican state attorneys general-led lawsuit that would overturn the Affordable Care Act (ACA). ...
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News Briefs

✦ Having now satisfied all necessary regulatory requirements, Centene Corp. and WellCare Health Plans, Inc. closed their $17 billion deal on Jan. 23. Centene is the country’s largest managed Medicaid insurer and...
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‘Hotspotting’ Study Stirs Debate About Social Determinants with Chart: Health Care ‘Hotspotting’ Program Shows Little Effect on Medically Complex Patients

In the health care industry, it’s become almost dogma that a small number of “superutilizers” — typically patients with complex medical and social challenges — are driving a disproportionate share of costs...
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© 2024 MMIT