The Medicare Advantage star ratings system, which determines an insurer's annual bonus for participation in the federal program, may face significant challenges because of a recent court ruling requiring the Centers for Medicare & Medicaid Services (CMS) to recalculate the 2026 star ratings for one insurer, Clover Health. The scope...
On Monday, the Centers for Medicare and Medicaid Services (CMS) finalized the Rate Announcement for Medicare Advantage (MA) and Medicare Part D programs for Calendar Year (CY) 2025 which includes a rate increase of 3.7% in addition to finalized Part D rules.
The final rule didn't deviate much from the CMS proposed payment rate issued...
A Direct Contracting Entity (DCE) before transitioning to the REACH ACO model, Clover Health's financial performance was worse than any other DCE, losing $30.4 million in 2021 and $51.7 million in 2022. The company said it is predicting quicker profits in its Medicare Advantage (MA) line of business.
On December 1, Clover Health...
Late last month, The Centers for Medicare and Medicaid Services (CMS) reported about 18,000 Arizona Medicare beneficiaries were aligned across more than a dozen REACH ACOs listed in the state in 2021; the majority earned shared savings - impressive numbers from Oak Street, Humana, and Iora Health and significant losses from Clover...
For the first quarter of 2023, Clover Health reported revenue of $527.8 million and a net loss of $72.6 million as Bright Health reported its revenue at $756 million and a net loss of $94.8 million. Also this week, Wall Street insiders are predicting a bankruptcy filing as soon as this weekend for the physician staffing company...National News
Insuretech companies have suffered some huge financial losses this year, as a result some of them are pulling away from certain Medicare markets and pivoting to other methods of improving business.
For the third quarter of 2022, Clover Health posted a $75.3 million net loss, but doubled its total revenue year-over-year from $427...National News
If insuretech startups promised one thing, it was that they had a bulletproof plan to game the insurance market, attract a ton of enrollees to their plans and produce hand-over-fist returns for their investors. After several quarters of substantial losses, investors are losing interest and companies like Oscar Health, Clover Health and...Arizona News
This week in Medicare Advantage news, prior authorization reform garners the support of the Better Medicare Alliance, Puerto Rico offers insight into the future of the MA program, a CMS rule on third-party marketing goes into effect and we share some acquisition news.
Last week, the Better Medicare Alliance, the largest lobby for...National News
Health insurance technology startups have struggled to meet industry expectations, with several of the most lauded companies losing money quarter-to-quarter despite significant growth. But these insuretech startups' CEOs are receiving ample bonuses despite poor corporate performance.
A few recent examples: Bright Health Group recorded...
It has been nearly a year since the Biden administration's Center for Medicare and Medicaid Innovation (CMMI) placed the Medicare Direct Contracting model (DC) under review. The Centers for Medicare and Medicaid Services (CMS) said last week that a decision on the alternative payment model (APM) would come "soon," leaving investors and...
Medicare Advantage and the hundreds of investors pumping venture capital into new MA startups rely on one thing: MA growth. For the past several years, MA has been on a quick trend upward, but as it currently only captures under 50% of the market, some are left wondering if the seemingly endless demand isn't just a giant investment...
The Centers for Medicare & Medicaid Services (CMS) released key information for Medicare Advantage and Part D prescription drug plans in advance of the 2022 annual open enrollment period (OEP). Marketing and advertising for most MA plans starts October 1 with plan sales beginning October 15 and ending December 7, 2021.
Arizona...
This week Humana signed a definitive agreement to acquire One Homecare Solutions (“onehome”) from WayPoint Capital Partners (a private equity affiliate of a family investment office). This acquisition will continue Humana’s strategy to create a value-based home health offering. One Homecare Solution's offers a variety of home-based...CMS Rules
Medicare's older adults still like their coverage and report fewer cost-related problems than privately insured adults ages 50 to 64, despite receiving similar care to that age bracket.
The study from Kaiser Family Foundation said that rapidly growing healthcare spending is of concern for consumers and the relatively high prices from...News
A rheumatologist and president of the Coalition of State Rheumatology Organizations wonders why Cigna patients with psoriasis received the lure of a $500 debit card to switch to a different medication, "if ever a single letter succinctly encapsulated the insanity of the U.S. drug pricing system, this was it," she said. Also this week,...Arizona News
Just in time for 2021 Medicare Advantage enrollment, startup Clover Health partnered with Walmart to launch health insurance plans. Subsequently, the company entered a merger with Social Capital Hedosophia Holdings Corp. and will shortly become publicly traded.
Walmart announced the opening of Walmart Insurance Services last week, in...National News
Clover Health also announced an initial research partnership and license agreement with Genentech, a biotechnology company which discovered the first targeted antibody for cancer and the first medicine for primary progressive multiple sclerosis.
Ex-Pfizer exec Cheng Zhang will lead Clover Therapeutics; Endpoint news is reporting that...Arizona News
San Francisco-based Clover Health plans to launch Medicare Advantage plans in six new cities in 2019, including Tucson, Arizona. Like Oscar Health, Clover is technology focused and uses data analytics as well as artificial intelligence to better serve its patient population.
Oscar Health, the newest ACA exchange insurer to enter...
