April

Hospitals Are Slow to Make Negotiated Prices Transparent

With Chart: Most Big Hospitals Are Not Complying With Price Transparency Rule

April 16, 2021

Several recent studies indicate that providers have been slow to fully comply with a 2019 Trump administration final rule requiring hospitals to disclose pricing information to consumers. The hospital price transparency regulation, which met stiff legal opposition from industry groups including the American Hospital Association, has not been enforced with gusto by the Biden administration, but experts say that might change — and that the rule isn’t going anywhere.

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With IPO Talk, Telehealth Buy, Startup’s Future May Be Bright

With Chart: Bright Health’s Membership, at a Glance

April 16, 2021

After 2020 proved to be a banner year for initial public offerings, three separate startup health insurers — Alignment Healthcare, Clover Health and Oscar Health — rode the wave and launched IPOs in the early months of 2021. Now, Bright Health Inc. is reportedly poised to become the fourth insurer to do so, and in the meantime has picked up a telehealth asset for good measure.

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UnitedHealth Expects Pent-Up Care to Return Later in ’21

April 16, 2021

UnitedHealth Group began the first quarter of 2021 on a high note, reporting earnings per share (EPS) and a medical loss ratio (MLR) that both beat the Wall Street consensus estimate and saying it expects to achieve greater full-year earnings than it previously estimated. However — mirroring much of the messaging last year when the COVID-19 pandemic was massively depressing routine and elective care — executives warned that the majority of the unfavorable COVID impact they’re expecting will transpire in the second half of the year.

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MedSupp Presents Disruption Opportunity for MA Plans

April 16, 2021

Medicare beneficiaries who shopped and made a coverage change during this last Annual Election Period (AEP) were more likely to stick with their current insurer than in years past, illustrating the dual need for insurers to engage with consumers throughout the year and to innovate with benefits that will attract and retain satisfied members, according to experts speaking at a recent webinar co-hosted by Deft Research and GHG Advisors. At the same time, Medicare Supplemental (MedSupp) customers are showing increased interest in Medicare Advantage, presenting more opportunities to disrupt that market.

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News Briefs

April 16, 2021

✦ Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) grew by 10.8% between February and November 2020 to approximately 78 million, according to an issue brief by the Kaiser Family Foundation (KFF). The growth in the safety-net insurance programs follows a two-year trend of declining enrollment. “Increases in enrollment reflect changes in the economy (as more people experience income and job loss and become eligible and enroll in Medicaid and CHIP coverage) and provisions in the Families First Coronavirus Response Act (FFCRA) that require states to ensure continuous coverage to current Medicaid and CHIP enrollees to access a temporary increase in the Medicaid/CHIP match rates,” the brief said. Read more at https://bit.ly/39Lg97F.

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Ohio Medicaid Defers Buckeye Renewal as Centene Suit Lingers

April 15, 2021

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 2022. One notable exclusion from that group was Buckeye Community Health Plan, the Ohio subsidiary of Centene Corp. that received a designation of “Defer” as alleged violations of its current pact with ODM are the subject of ongoing litigation and, according to one industry expert, could have devastating effects for Centene.

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