PA launches website for patients to dispute denials
Plus: CMS sanctions four Medicare Advantage plans
Good morning and happy Friday. Welcome to the Friday Pulse Check from Fulcrum Strategies.
In the news:
Trinity Health and Anthem agree to multi-year value-based deal using Epic
Livonia, Michigan-based Trinity Health and Anthem BCBS have agreed to a new deal using Epic’s electronic health record system to pay the hospital on a value-based basis, marking a strong move away from the fee-for-service model that so many hospitals and providers have become accustomed to. The deal also creates new preventative care initiatives that include annual checkups for patients and administrative reviews. Read more in Becker’s Payer Issues.
PA launches new website for patients to dispute denied claims
As more and more lawsuits are brought against the major payers for wrongfully denying claims, the state of Pennsylvania has launched a new website for patients in that state to dispute claims they believe their health plan incorrectly denied. The state Department of Insurance says that patients still have to dispute the claim with their carrier first and only after they are issued a final adverse determination letter can they approach the state. Pennsylvania has contracted with several independent consulting groups to review the claims and says they have certified there is no conflict of interest between health plans and the companies reviewing the claims. It is likely more states will begin to launch similar websites as more scrutiny is put on the payers for denying routine claims. Check out the website for yourself.
Other articles of interest:
Hawaii nurses plan seven-day strike - The Star Advertiser
CMS terminates several Medicare Advantage prescription drug plans and suspends all marketing and enrollment activities including: Zing Health, Clear Spring, and Centene’s WellCare in Arizona and North Carolina - Becker’s Payer Issues
What would a Nikki Haley healthcare plan look like? - KFF Health News
FDA allows Ron DeSantis and Florida to import drugs from Canada - STAT News
Opinion: Sorry, but the “drugs from Canada” don’t work - The New York Post
Mark Cuban’s Cost Plus Drug Company signs deal with another small payer - BusinessWire
California Watch: Gavin Newsom thinks more about $25/hr minimum wage for healthcare workers - KFF Health News
The FLATLINING Podcast from Fulcrum Strategies
This week on the podcast, Ron and I followed up on several stories about healthcare giant Cigna that broke towards the end of the year.
First, we discussed the failed Cigna / Humana merger. Analysts on Wall Street were concerned about that deal from the get-go from an investment perspective. Healthcare watchers were nervous about what would happen to patients. Ultimately the deal failed and Ron and I talked about why.
Then we discussed the news that Cigna has found a buyer for its struggling Medicare Advantage business. Cigna got into the Medicare Advantage business when it purchased Healthspring for $3.8 billion in 2011. Since then, the product has been rife with poor management and missteps along the way. It has struggled to gain new enrollees and it went through a phase where Cigna was barred by CMS from enrolling new members. Reuters reported that Cigna will likely sell the product to HCSC for nearly $4 billion. Ron and I discussed why the product struggled and what it could mean for patients.
Subscribe to the FLATLINING Podcast on Apple Podcasts, Spotify, the iHeartRadio app, Amazon Music, Google Podcasts, Stitcher, Pandora, TuneIn, and Audible.
A brief look at Wall Street:
LIVE Cigna stock price: CI 0.00%↑
LIVE Humana stock price: HUM 0.00%↑
LIVE Elevance stock price: ELV 0.00%↑
LIVE Centene stock price: CNC 0.00%↑
LIVE UnitedHealth Group stock price: UNH 0.00%↑
UnitedHealth Group announced a $5.5 billion profit in Q4 2023
Have a good weekend,
Matthew