Examining the Five Biggest Players in Medicaid Managed Care
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
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
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
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
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
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
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
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
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
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
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
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
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
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.
New Batch of Managed Care Contracts Will Provide Care to 600,000 People in US
Around 600,000 managed care contracts have been signed off by the Minnesota Department of Human Services last week. The deal will serve patients across the US state of Minnesota, with plans coming from 9 different payers. The contracts will begin this coming New Years Day
$14 Million Settlement Reached in Case Between PBM and Largest Managed Care Payer in US
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
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
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.
US Government Accountability Office Report on State-Directed Medicaid Payments in Managed Care
The US Government Accountability Office (GAO) released a new report on state-directed payments of Medicaid funds to managed care plans. [...]
Study Indicates Insurers Inflate Medicaid Physician Networks
Insurers may be artificially padding their Medicaid physician networks, according to a study published in Health Affairs. The authors found [...]
The Downsides of Healthcare Consolidation
Over the past few decades, many healthcare organizations have consolidated to cut the labor costs incurred by their steadily growing [...]
Highlights from AMCP 2022
The Academy of Managed Care Pharmacy convened last week for its annual meeting, bringing nearly 3,000 pharmacists and other healthcare [...]
Understanding Managed Care’s Focus On Prescription Drug Spending
Although managed care began with a focus on physician and hospital services, this focus has shifted in recent years towards [...]
