This is Jacob Emerson with the Becker payer
issues podcast.
Here's your Bi weekly industry news briefing for
May twentieth.
Opt is closing a change healthcare facility in
Toledo, Ohio,
resulting in the termination of a hundred and
29 employees located in Ohio or or remotely.
The layoffs at the 93000
square foot facility will occur in 3 waves
from July fifteenth to September 6,
According to regulatory documents filed with the state
on May sixteenth.
United Health Group is facing a proposed securities
fraud class action lawsuit. Alleging that the company
failed to disclose that the justice department opened
an antitrust investigation into the organization. The investor
investigation come came into the public's attention in
February when the Wall Street Journal and other
news outlets reported that the justice department was
investigating the relationships between the company's various segments,
including Opt.
Neither the Doj nor United Health has publicly
acknowledged the
investigation. As a result of those reports the
price of United health stock declined by 27
dollars per share, erasing nearly 25000000000
dollars in shareholder value. According to the lawsuit
filed May fourteenth in a Minnesota Federal Court.
The lawsuit from the city of Hollywood firefighters
pension fund, alleges that United Health was aware
of the investigation since at least October.
The lawsuit said, quote, instead of disclosing this
material investigation to investors or the public,
United Health, executives sold more than 120000000
dollars of their personally held United Health shares.
In the 4 months between learning that the
Doj
investigation and the investigation becoming public,
United Health Chairman, Stephen Hem, sold over a
hundred million dollars of his personally held United
Health shares. And Brian Thompson, the Ceo of
United Healthcare sold over 15000000 dollars. Of his
personally held United Health shares.
Mister Ham and, Mister Thompson are named as
defendants in the lawsuit. United Health group Ceo,
Andrew Witty, who did not sell share was
also named as a defendant.
United Health Group executives also say that they're
not planning any major shake up. To their
Medicare Advantage Business as other insurers plan to
pull back their offerings in 20 25.
At May fourteenth investor presentation,
Brian Thompson, the Ceo of United Healthcare said
medical cost trends and rates from Cms are
in line with the company's
expectations. He said, quote, I'm really comfortable with
what we'll put into the marketplace for next
year, and pleased with how we're performing and
what the opportunities are on the horizon for
20 25.
Medicare advantages facing major headwind, including including rising
medical costs and lower reimbursement rates from Cms.
2 of United Health major competitors, Cvs health
and Human said they expect to lose members
in 20 25.
Both companies said they plan to exit counties
where they do not expect to be profitable.
And they may cut back benefits in some
plans to account for rising medical costs.
At the beginning, of 20 24, Cms implemented
changes the Medicare managed risk adjustment changes that
the payer industry opposed.
That model is being phased in over 3
years.
Well, great plains health, a health system
headquartered a North Platt in Nebraska,
plans to stop contracting with all Medicare advantage
plans. In 20 25.
That includes the systems clinics and independent practices,
which will drop Cent blue across the shield
and United Health
care M plans in 20 25.
The system said May sixteenth that it was
in... Also encouraging patient stock opt for traditional
Medicare in 20 25 to continue receiving care
from great plains health providers.
Opt This Health System's Chief Medical officer said
that to put the patient first, we can
no longer be under contract with the plan
that causes significant delays and care, longer hospital
stays and outright denials of care.
And finally, Blue Cross Blue Shield, Michigan has
named Tricia Keith as it's now president and
Ceo effective in 20 25.
Miss Keith is the first woman to lead
the Detroit based payer, and she currently serves
as executive vice President, Coo and President of
emerging markets. She's been with the company since
2006
She succeeds Daniel Le, who is retiring after
leaving leading the company for 17 years, 1
of the longest serving Ceos across all across
blue shield plans.
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