Examining the Five Biggest Players in Medicaid Managed Care

July 7th, 2023|Categories: Featured, Industry News|Tags: , , , , |

With over 70% of Medicaid beneficiaries being enrolled in plans from managed care organizations (MCOs), managed care has become a major player in the American health insurance industry. A new article by the Kaiser Family Foundation (KFF) takes a look at five of the largest MCOs and how they are influencing the managed care landscape.

Study Finds Americans with Health Issues Sticking with Managed Care Plans

June 28th, 2023|Categories: Featured, Industry News|Tags: , , , , |

A recently published study in JAMA finds that sicker patients of advanced age tend to stick with managed care plans. This is a change of pace from recent years, when the industry was decried for preferentially selecting healthier patients. The study was conducted using Medicare enrollment data taken from 45,000 patients.

Wells Fargo Sees Opportunities in Managed Care Stock Sell-Off

June 21st, 2023|Categories: Featured, Industry News|Tags: , , , , |

A wave of stock sell-offs in the managed care industry represent a buying opportunity, according to analysts at Wells Fargo. The sell-offs were sparked by comments from UnitedHealth and Humana that noted an uptick in procedures covered by Medicare Advantage plans that were likely postponed during the pandemic.

How New CMS Rules to Cut Appointment Wait Times Will Affect Managed Care

June 9th, 2023|Categories: Featured, HEOR Feature, Industry News|Tags: , , , |

Research shows that new patients have to wait an average of 26 days for an appointment in 15 major US cities. To tackle this problem, the Centers for Medicare and Medicaid Services (CMS) recently proposed a rule entitled the Notice of Proposed Rulemaking Managed Care Access, Finance, and Quality (NPRM). The NPRM would cap appointment wait times for primary care, mental health, and substance use disorder treatment.

New Proposed CMS Medicaid and CHIP Managed Care Rule Targets Access, Quality, and Payment Rates

May 11th, 2023|Categories: Featured, Industry News|Tags: , , , , |

A newly released proposed rule by the US Centers for Medicare and Medicaid Services (CMS) targets transparency, quality, care access, and payment rates for Medicaid and Children’s Health Insurance Program (CHIP) managed care. States would need to provide an annual payment analysis of all managed cares payment rates for a variety of services. In addition, states will need to develop a quality rating system for Medicaid and CHIP plans.

Talking Immunology Biosimilars and Managed Care with Dr. Colby Evans

May 10th, 2023|Categories: Featured, Industry News|Tags: , , , , |

Biosimilars have taken an increasingly prominent role in healthcare in recent years, representing a significant point of savings for patients and managed care organizations (MCOs). However, there are still some significant challenges to increase their utilization. In a new AJMC interview, Dr. Colby Evans of Evans Dermatology Partners discusses these hurdles. The first is that patients and providers are often unwilling to make the change from more expensive reference drugs.

28 US States Will See Medicaid Enrollment Drop to Near Pre-Pandemic Levels

April 5th, 2023|Categories: Featured, HEOR Feature, Industry News|Tags: , , , , |

Just as US states begin the Medicaid redetermination process, a new report by Moody’s Investors Services finds that 28 states will see enrollment drop to numbers equivalent to pre-pandemic levels. Some states, the report notes, will settle on enrollment levels higher than those seen before the pandemic-era Medicaid redetermination pause.

How New Advancements in Pharmacy are Shifting the Managed Care Landscape

April 4th, 2023|Categories: Featured, Industry News|Tags: , , , , |

Pharmacies are changing, sending ripples into the managed care landscape. In a new Managed Healthcare Executive article, Joe Johnson, Todd Clark, and Brendan Mitchell of LEK Consulting discuss new disruptive pharmacy models and how they are affecting managed care and other payers. The first such shift is a move towards better patient access to care decided upon by their provider.

ADA Calls for More Oversight and Transparency from Medicaid Managed Care Plans

February 28th, 2023|Categories: Featured, Industry News|Tags: , , , |

In a new letter to the Centers for Medicare and Medicaid Services (CMS), representatives from the American Dental Association have asked for increased transparency regarding medical loss ratio (MLR) reporting from Medicaid managed care plans. The authors pointed out that many states were missing substantial chunks of MLR data in recent years.

Oppenheimer Analysts: Keep an Eye on Managed Care

February 15th, 2023|Categories: Featured, Industry News|Tags: , , , |

A note to clients from Oppenheimer recommends that investors carefully watch managed care industry. Analysts say that a group of major managed care firms like Centene, Cigna, and UnitedHealth, have underperformed so far this year, in part because uncertainty surrounding the impending end of the COVID-19 public health emergency.

Seven Payer Exec’s Takes on Medicaid Redeterminations

February 10th, 2023|Categories: Featured, Industry News|Tags: , , , |

State will shortly begin the Medicaid redetermination process as the pandemic-era continuous coverage requirements expire with the end of the COVID-19 public health emergency. This leaves many payers preparing to lose members. Learn what 7 different payer execs expect with the redetermination process in a new Becker’s Payer Issues article.

San Diego Non-Profit and Managed Care Company Brings Free Healthcare to Unhoused People

November 1st, 2022|Categories: Featured, HEOR Feature, Industry News|Tags: , , , , |

A non-profit team of clinicians is providing comprehensive care to San Diego’s unhoused population in a partnership with Medi-Cal, a medical provider for low-income people in California, and Molina Healthcare of California, a managed care company. The team, called Healthcare in Action, is comprised of five clinicians who work five days a week to give unhoused people care for chronic conditions and, critically, mental illnesses.

Managed Care Pharmacists in High Demand

October 14th, 2022|Categories: Featured, Industry News|Tags: , , , |

Panel speakers at this year’s Academy of Managed Care Pharmacy Nexus meeting highlighted the abundance of opportunities for managed care pharmacists. Managed care pharmacists are responsible for coordinating efforts of pharmacy networks and investigating drug utilization trends. The speakers noted that opportunities are opening up as the managed care industry expands.

OptimizeRX’s AI-Based RWE Platform Shows Positive Results for Patient Engagement Application

October 14th, 2022|Categories: Featured, Industry News|Tags: , , , |

The medical point-of-care tech company OptimizeRx has announced positive results from the implementation of its artificial intelligence-based (AI) real-world evidence (RWE) platform. A specialty pharmacy company used OptimizeRX’s platform to help identify potential applicable patients using electronic health record (EHR) data and inform their providers of available treatments.

$14 Million Settlement Reached in Case Between PBM and Largest Managed Care Payer in US

September 30th, 2022|Categories: Featured, Industry News|Tags: , , , , |

MassHealth has reached a $14 million settlement with the Centene Corporation, a major pharmacy benefit manager (PBM), as announced by the state’s attorney general (AG), Maura Healey. MassHealth is the largest Medicaid managed care payer in the US and has been embroiled in a legal battle with Centene, over claims the company had failed to provide the discounts and rebates it promised to the state, jacking up costs.

Half of Medical Loss Reports are Incomplete

September 28th, 2022|Categories: Industry News|Tags: , , , , |

The US Office of Inspector General (OIG) announced that nearly half of the medical loss reports (MLR) submitted by Medicare managed care plans were incomplete. The plans are supposed to send reports containing specific information, including data for MLR calculations. As a result, the OIG is calling for more oversight at the state level.

The Impact of Alzheimer’s Care: A Managed Care Perspective

September 13th, 2022|Categories: Featured, Industry News|Tags: , , , , |

Alzheimer’s is the most common cause of dementia, affecting 6.5 million people in the US alone. Unfortunately, a crisis is brewing in many countries aging populations; the number of people facing the disease will double in the next 40 years. A newly published article in AJMC breaks down the societal and economic impact of the disease and explains the role of managed care in the relieving this burden.

Go to Top