News Briefs

✦ Reporting earnings for the first time since going public in March, Alignment Healthcare, Inc. posted a net loss of $56.9 million for the first quarter of 2021, compared with a net loss of $10 million in the year-ago quarter. It also recorded a medical loss ratio (MLR) of 91.5% and expects to end the year in the “high 80s,” Founder and CEO John Kao stated during a May 17 earnings conference call. In addition to 32% year-over-year growth in its Medicare Advantage membership, Kao disclosed that Alignment launched two Direct Contracting Entities (DCEs) under the name Axceleran that are serving about 5,800 fee-for-service Medicare lives in California and North Carolina. Meanwhile, Clover Health during its own May 17 earnings call disclosed that it was serving at least half as many Medicare lives as a DCE than it originally projected (RMA 4/15/21, p. 1). In addition to serving more than 66,300 MA members as of March 31, Clover CEO Vivek Garipalli told analysts that the company on April 1 added another 65,000 individuals “through claims alignment alone” as a DCE. In a slide deck presented to investors prior to going public in January, the insurer said it had 200,000 DCE members “already under contract for 2021.” Garipalli during the earnings call said Clover believes it has “access to up to 200,000 Medicare beneficiaries through our contracts with participating providers” and expects to end the year with between 70,000 and 100,000 total aligned beneficiaries. For the quarter ending March 31, Clover reported a consolidated MLR of 107.6%, compared with 89.4% during the first quarter of 2020, largely due to COVID-19 costs, and posted a net loss of $48.4 million, up from a loss of $28.2 million for the year-ago quarter. Read more at https://bit.ly/3wyKZcn and https://bit.ly/3u1H9q8.

✦ After failing to secure funding to implement voter-approved Medicaid expansion, the Missouri Dept. of Social Services (DSS) on May 13 submitted a letter to CMS formally withdrawing its State Plan Amendments for MO HealthNet expansion. A Missouri appellate court in June 2020 ruled that the ballot initiative, which was approved in August 2020, did not create a revenue source or direct the General Assembly to appropriate funds, thereby giving the GA discretionary authority to fund or not fund expansion, noted a press release from Gov. Mike Parson (R). The GA on May 7 finalized the state’s fiscal year 2022 budget without funding for MO HealthNet expansion or appropriation authority to DSS or the governor. The DSS had estimated that the expansion would cost the state approximately $1.9 billion, which was included in the governor’s recommended budget. Read more at https://bit.ly/33N8VfJ.

© 2024 MMIT
Lauren Flynn Kelly

Lauren Flynn Kelly Managing Editor, Radar on Medicare Advantage

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.

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