News Briefs

News Briefs

November 5, 2021

Politan Capital Management LP, a new hedge fund led by longtime activist investor Quentin Koffey, plans to use its $900 million stake in Centene Corp. to replace several of the carrier’s board members, the Wall Street Journal reported on Nov. 3. Politan hopes to increase margins at the insurer, which have been lower than those at other large carriers. According to the Journal, Politan wants to put former WellCare CEO Kenneth Burdick and former Anthem, Inc. Chief Financial Officer Wayne DeVeydt on Centene’s board. In a Nov. 3 statement responding to the story, Centene pointed out it launched a margin-boosting plan at its June investor conference. “While the activist activity is noteworthy, it comes at a time when [Centene] has announced to the markets that it is looking to reposition itself for margin expansion instead of its historical practice of focusing on greater topline growth,” Citi analyst Ralph Giacobbe wrote in a Nov. 3 note to investors. “That said, [Centene’s] shares have languished/underperformed peers over the last several years, and we would imagine some level of investor support around a Board refresh is not out of the question, particularly if the new Board slate includes trusted industry veterans.”

Politan Capital Management LP, a new hedge fund led by longtime activist investor Quentin Koffey, plans to use its $900 million stake in Centene Corp. to replace several of the carrier’s board members, the Wall Street Journal reported on Nov. 3. Politan hopes to increase margins at the insurer, which have been lower than those at other large carriers. According to the Journal, Politan wants to put former WellCare CEO Kenneth Burdick and former Anthem, Inc. Chief Financial Officer Wayne DeVeydt on Centene’s board. In a Nov. 3 statement responding to the story, Centene pointed out it launched a margin-boosting plan at its June investor conference. “While the activist activity is noteworthy, it comes at a time when [Centene] has announced to the markets that it is looking to reposition itself for margin expansion instead of its historical practice of focusing on greater topline growth,” Citi analyst Ralph Giacobbe wrote in a Nov. 3 note to investors. “That said, [Centene’s] shares have languished/underperformed peers over the last several years, and we would imagine some level of investor support around a Board refresh is not out of the question, particularly if the new Board slate includes trusted industry veterans.”

Thomas Jefferson University Hospitals Inc., a Philadelphia non-profit health system branded as Jefferson Health, will fully acquire managed care organization HealthPartners Plans from Temple University Health System for $305 million. The providers previously held 50% stakes in the 290,000-member health plan, per a Nov. 1 press release. In a statement, Jefferson Health President Bruce A. Meyer, M.D., said the move will help HealthPartners Plans “care for more marginalized patient populations and provide access to critical, lifesaving and value-based care.”

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News Briefs

November 5, 2021

✦ Politan Capital Management LP, a new hedge fund led by longtime activist investor Quentin Koffey, plans to use its $900 million stake in Centene Corp. to replace several of the carrier’s board members, the Wall Street Journal reported on Nov. 3. Politan hopes to increase margins at the insurer, which have been lower than those at other large carriers. According to the Journal, Politan wants to put former WellCare CEO Kenneth Burdick and former Anthem, Inc. Chief Financial Officer Wayne DeVeydt on Centene’s board. In a Nov. 3 statement responding to the story, Centene pointed out it launched a margin-boosting plan at its June investor conference.

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News Briefs

November 4, 2021

CMS on Nov. 2 finalized changes intended to boost participation in the Medicare Diabetes Prevention Program (MDPP) expanded model. In the Calendar Year 2022 Physician Fee Schedule final rule, CMS finalized proposals to waive the Medicare enrollment fee for MDPP suppliers beyond the end of the public health emergency, shorten the program services period to one year by eliminating the second year of maintenance sessions, and redistribute all of the Ongoing Maintenance sessions phase performance payments to certain Core and Core Maintenance Session performance payments.

CMS on Nov. 2 finalized changes intended to boost participation in the Medicare Diabetes Prevention Program (MDPP) expanded model. In the Calendar Year 2022 Physician Fee Schedule final rule, CMS finalized proposals to waive the Medicare enrollment fee for MDPP suppliers beyond the end of the public health emergency, shorten the program services period to one year by eliminating the second year of maintenance sessions, and redistribute all of the Ongoing Maintenance sessions phase performance payments to certain Core and Core Maintenance Session performance payments.

The 2022 Medicare Advantage landscape is looking more robust than ever, with a record 3,834 MA plans available across the country, up 8% from 2021, according to a Kaiser Family Foundation (KFF) analysis. On average, beneficiaries will have 39 plans to choose from in their local market, compared with 33 plan options in 2021, KFF observed. However, because of consolidation in the stand-alone Prescription Drug Plan market, the typical Medicare beneficiary will have 23 PDP options next year, down from 30 in 2021, added KFF. Meanwhile, a separate analysis from Drug Channels found that 66% of MA-PD plans and 98% of stand-alone PDPs will have a preferred cost sharing network (i.e., preferred pharmacy network) in 2022. According to that analysis, 92% of the total 766 PDPs in 2022 are operated by one of eight major insurers, which all have preferred cost sharing networks.

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News Briefs

November 4, 2021

✦ CMS on Nov. 2 finalized changes intended to boost participation in the Medicare Diabetes Prevention Program (MDPP) expanded model. In the Calendar Year 2022 Physician Fee Schedule final rule, CMS finalized proposals to waive the Medicare enrollment fee for MDPP suppliers beyond the end of the public health emergency, shorten the program services period to one year by eliminating the second year of maintenance sessions, and redistribute all of the Ongoing Maintenance sessions phase performance payments to certain Core and Core Maintenance Session performance payments.

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News Briefs

October 29, 2021

The Biden administration released a diminished version of its proposed spending package, and several health care policies coveted by progressive Democrats — including drug price reform — are among the items that got cut. Critically, Medicare drug price negotiation is not included in the so-called “Build Back Better framework.” However, House Speaker Nancy Pelosi (D-Calif.) reportedly was working on a last-ditch effort to include some drug-pricing provisions. The package would extend the expanded tax credits for Affordable Care Act exchange premiums, made available during the pandemic, to 2025, and Medicare would be expanded to include hearing benefits, but would not include vision or dental.

The Biden administration released a diminished version of its proposed spending package, and several health care policies coveted by progressive Democrats — including drug price reform — are among the items that got cut. Critically, Medicare drug price negotiation is not included in the so-called “Build Back Better framework.” However, House Speaker Nancy Pelosi (D-Calif.) reportedly was working on a last-ditch effort to include some drug-pricing provisions. The package would extend the expanded tax credits for Affordable Care Act exchange premiums, made available during the pandemic, to 2025, and Medicare would be expanded to include hearing benefits, but would not include vision or dental.

The annual Kaiser Family Foundation (KFF) Medicaid Budget Survey found that, in a majority of the 47 surveyed states, 75% or more of Medicaid enrollees are members of a managed care organization (MCO) run by a private carrier. KFF produced the survey with help from Health Management Associates and the National Association of Medicaid Directors. The survey also found enrollment in Medicaid MCOs has grown since the start of the pandemic, as has Medicaid enrollment as a whole. On balance, states added more benefits to Medicaid than they removed in 2021: “most states used Medicaid emergency authorities to temporarily adopt new benefits, adjust existing benefits, and/or waive prior authorization requirements,” KFF said.

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News Briefs

October 29, 2021

The Biden administration released a diminished version of its proposed spending package, and several health care policies coveted by progressive Democrats — including drug price reform — are among the items that got cut. Critically, Medicare drug price negotiation is not included in the so-called “Build Back Better framework.” However, House Speaker Nancy Pelosi (D-Calif.) reportedly was working on a last-ditch effort to include some drug-pricing provisions. The package would extend the expanded tax credits for Affordable Care Act exchange premiums, made available during the pandemic, to 2025, and Medicare would be expanded to include hearing benefits, but would not include vision or dental.

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The Biden administration released a diminished version of its proposed spending package, and several health care policies coveted by progressive Democrats — including drug price reform — are among the items that got cut. Critically, Medicare drug price negotiation is not included in the so-called “Build Back Better framework.” However, House Speaker Nancy Pelosi (D-Calif.) reportedly was working on a last-ditch effort to include some drug-pricing provisions. The package would extend the expanded tax credits for Affordable Care Act exchange premiums, made available during the pandemic, to 2025, and Medicare would be expanded to include hearing benefits, but would not include vision or dental.
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