Health Plan Weekly

  • Medicaid Officials Warn Insurers: Reform Prior Auth Before Politicians Do

    Speaking at an AHIP conference in Baltimore on March 13, two state’s top Medicaid officials shared frank views about the tensions that arise from working with private managed care plans to run their Medicaid programs — especially as scrutiny of insurer practices like prior authorization is intensifying.  

    “We talk a lot internally about the fact that if I were to stand somebody from my agency — the Medicaid agency — next to somebody from a Medicaid managed care company, from a mission perspective, you will not see a single difference between the two,” said Jay Ludlam, deputy secretary of NC Medicaid, during the AHIP Medicare, Medicaid, Duals & Commercial Markets Forum. 

  • Change Healthcare Faces Lawsuits, Could Lose Clients After Data Breach

    UnitedHealth Group could face significant financial and legal consequences amid the ongoing cyberattack on its Change Healthcare subsidiary. A federal regulator is investigating the diversified health care giant for possible HIPAA violations; patients and providers have filed lawsuits; and the firm was forced to suspend prior authorization in many cases, which may hurt the bottom line of its UnitedHealthcare insurance arm, according to Wall Street analysts. 

    In addition to these immediate problems, Change Healthcare may lose the leading position it holds in its areas of operation. Some providers and insurers have already begun to switch to other revenue cycle management platforms and claims clearinghouses, one expert tells AIS Health, a division of MMIT. 

  • Oscar, Clover, Alignment Make Progress Toward Profitability

    The software-focused startup insurers known as “insurtechs” last year made tangible strides toward reaching profitability, according to their full-year earnings reports, backing up their executives’ statements that 2024 may see break-even results or better.  

    Financial institutions generally took a positive view toward Oscar Health Inc., Alignment Healthcare Inc. and Clover Health Investments Corp., but some analysts tempered their praise by pointing out holes in the firms’ growth and profitability strategies. 

    One former insurtech, the erstwhile Bright Health Group, Inc., exited the insurance business altogether, and now operates as a care delivery-focused business under the name NeueHealth. 

  • Cigna Raises Long-Term Earnings Projections, Cites Specialty as Driver

    During its March 7 Investor Day, The Cigna Group raised its long-term earnings projection and highlighted the diverse offerings it believes will win client business and differentiate itself from competitors. The company placed particular emphasis on opportunities in the specialty pharmacy area, where it already has a strong foothold and plans on expanding in the coming years.  

    Cigna increased its long-term adjusted earnings per share (EPS) guidance range to an average growth of 10% to 14% per year, up from a range of 10% to 13%. For 2024, it kept its adjusted EPS target of at least $28.25, up from $25.09 last year.  

  • Hacking, Ransomware Continue to Plague Health Care Industry

    The Biden administration has launched an investigation into UnitedHealth Group following the cyberattack on its subsidiary Change Healthcare, which caused significant disruption in payments and claims processing for pharmacies and health systems across the nation. Cyberattacks targeting the nation’s largest insurer — UnitedHealthcare — have been on the rise in recent years and exposed almost 750,000 patient records in 2023 alone, according to the HHS Office for Civil Rights (OCR).

    Since 2010, UnitedHealthcare reported 21 data breaches to OCR that affected more than 829,000 members, with six of them caused by hacking or IT incidents. As of March 14, the most recent Change Healthcare data breach has not been filed to the OCR breach portal. To meet the requirements of the HIPAA Breach Notification Rule, OCR must be notified within 60 days of the discovery of a data breach.

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