Radar on Medicare Advantage

News Briefs

✦ Oklahoma lawmakers at press time were attempting to replace Republican Gov. Kevin Stitt’s plan to transition fee-for-service Medicaid beneficiaries to a managed care model later this year, which will include ...
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Ohio Medicaid Defers Buckeye Renewal as Centene Suit Lingers

More than three months after the intended award announcement date, the Ohio Dept. of Medicaid (ODM) on April 9 named six managed care organizations that will serve its newly redesigned Medicaid program starting in 2...
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MAOs Dabble in FFS Medicare Via Direct Contracting Model

As CMS kicks off the first performance year of a new care delivery model — in which provider groups and other entities will share risk and receive capitated payments for serving fee-for-service Medicare beneficiar...
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Federal Report on HIP 2.0 Offers Lessons for Holdout States

As holdout states consider whether to accept the Biden administration’s offer of enhanced federal funding to expand Medicaid, a recent evaluation report on Indiana’s conservative Medicaid expansion demonstration...
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Centene Alleges ‘Misunderstanding,’ Seeks Transparent Resolution in Ohio Medicaid Dispute

As Centene Corp. defends allegations made by the Ohio Attorney General regarding its pharmacy benefit practices, recent court filings indicate the company’s strong desire to clear the air in a public way. At the s...
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News Briefs

✦ First-quarter 2021 revenues for UnitedHealth Group increased 9% from the year-ago quarter to $70.2 billion, driven in part by growth in its UnitedHealthcare business, which recorded quarterly revenue of $55.1 b...
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Centene Becomes Target as Two States Rebid Medicaid Pacts

Centene Corp.’s handling of pharmacy benefits in its managed Medicaid contracts has now become the subject of separate investigations in two states. Following the news of Ohio’s attorney general suing Centene ov...
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Calif. Blues Plan Sees Promise in Diabetes Reversal Platform

Diabetes prevention and diabetes management are both key tenets of Medicare Advantage insurers’ approach to addressing this costly condition that impacts one in three Medicare enrollees. But one tech-savvy startup...
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OIG: T-MSIS Lacks Full Medicaid Managed Care Payment Data

A new review of the CMS Transformed Medicaid Statistical Information System (T-MSIS) found that most states did not provide complete or accurate data on managed care payments to providers for January 2020, according...
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News Briefs

✦ Aiding in its efforts to deliver timely care and meet members in their “preferred environments,” Anthem, Inc. on March 24 said it will buy home-based nursing management company myNEXUS, Inc. According to a...
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