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Contact Us to Gain Access | Report | Strategy CatalystFour Predictions for Medicare Advantage: What to Expect in the Next 2-3 Years

This brief has the essential insights extracted from our Medicare Advantage (MA) webinar.

Contact Us to Gain Access | Newsletter | Academy IQExecutive Edge: August 26, 2024

Welcome to the Executive Edge – our quick read on the market to help your teams stay up-to-speed on the latest happenings across healthcare.

Contact Us to Gain Access | Strategist | Strategy CatalystHumana and UHG will lose $1B+ with MA star ratings declines, as both sue

On Oct. 10, CMS released next year’s star ratings for Medicare Advantage plans. Overall, the share of beneficiaries enrolled in plans earning 4+ stars (eligible for bonus payments) fell from 74% in 2024 to 62% in 2025, a 12-percentage-point drop.

Contact Us to Gain Access | Report | Strategy CatalystPayvider Profiles

Contact Us to Gain Access | Strategist  | Strategy CatalystHumana’s CenterWell opening 23 clinics at Walmart locations

Humana announced plans to lease clinical space and open 23 senior-focused primary care clinics at Walmart stores in the first half of 2025. Financial terms were not disclosed.

Contact Us to Gain Access | Strategist  | Strategy CatalystFTC to sue major PBMs over drug rebate tactics

The FTC is preparing a lawsuit against the three largest PBMs—OptumRx, Express Scripts, and CVS Caremark—over allegations that they steered patients to more expensive drugs in exchange for manufacturer rebates.

Contact Us to Gain Access | Strategist | Strategy CatalystPharmacy woes: CVS and Walgreens continue to pull back as CVS replaces CEO

Negative headlines have continued to plague the struggling retail pharmacy sector.

Contact Us to Gain Access | Strategist | Strategy CatalystPayvider roundup: UHG’s new gold card program, CVS cuts 2024 forecast

Headwinds from MA utilization and Medicaid disenrollment are continuing to put a drag on payer profits, and policymakers are increasingly focused on prior authorization.

Contact Us to Gain Access | Strategist | Strategy CatalystIU Health sells its insurance business to Elevance

Indiana University Health has entered into an agreement to sell its insurance business (IU Health Plans) to Elevance Health for an undisclosed amount.

Contact Us to Gain Access | Strategist | Strategy CatalystThe Strategist in Brief: October 24, 2024

A brief summary of the top stories in this edition of The Strategist, now including an audio version.

Strategist | Strategy CatalystCVS stock drops 20% and Humana withdraws earnings outlook

In recent weeks, both CVS and Humana have faced financial setbacks related to their high exposure to Medicare Advantage, as they face unexpected increases in care utilization.

Contact Us to Gain Access | Strategist | Strategy CatalystHHS OIG says Health Risk Assessments are driving MA overpayments

The HHS Office of the Inspector General released a 38-page report finding that major MA insures including UHG and Humana have used health risk assessments and chart reviews to inflate Medicare payments via upcoding.

Contact Us to Gain Access | Strategist  | Strategy CatalystPayers flag rise in Medicaid utilization

Stock prices for UnitedHealth Group and Centene fell by 5% following reports that the payers are experiencing a mismatch between Medicaid enrollees’ care utilization and the rates that states pay.

Contact Us to Gain Access | Strategist  | Strategy CatalystCMS will recalculate MA star ratings after legal losses

CMS confirmed it will rework this year’s Medicare Advantage star ratings after facing a string of legal losses in cases brought by payers disputing recent methodological changes.

Contact Us to Gain Access | Strategist | Strategy CatalystCMS releases final MA rates

On April 1, CMS released its final rate announcement for MA in CY2024, choosing to make no significant changes to the proposal in January that cut payers’ benchmark rate.

Academy 360 | Academy 360Heard Around the C-Suite: Key Themes from THMA's Spring 2024 Forums

An overview of key insights and themes discussed across THMA’s Spring 2024 Forums

Contact Us to Gain Access | Strategist  | Strategy CatalystBipartisan bill looks to codify time limits on prior authorization in MA

A bipartisan bill to reform prior authorization in Medicare Advantage has been introduced in Congress with 130 representatives and 42 senators as sponsors, a signal of broad support.

Academy 360 | All-AccessOptimizing Revenue Cycle Efficiency Through Denials Management

Faced with the dual challenge of tighter margins and rising costs, Leading Health Systems are under intense pressure to optimize their revenue cycle management. A key component is denials management.

Contact Us to Gain Access | Strategist  | Strategy CatalystPWC projects rising costs for commercial insurers

The accounting firm PwC released a report estimating that commercial healthcare costs will grow by 8% next year, setting the stage for tougher contract negotiations.

Contact Us to Gain Access | Strategist | Strategy CatalystIn Case You Missed It: August 15, 2024

Our favorite reads from the past week, including STAT's coverage of the AI "Pepsi challenge" and a Wall Street Journal investigation into home visits in MA.