This is Jacob Emerson with the Becker pair
issues podcast podcasts. Here's your bi weekly industry
news briefing for July 20. Second.
Former employees with United Health Group's Opt and
its subsidiaries took to social media beginning July
eighteenth regarding another reduction in force within recent
months that those employees say occurred across parts
of the company.
Social media posts from terminated employees indicate that
positions at landmark health have been affected,
including behavioral health and social workers, along with
nurse practitioners that In 20 22, Landmark became
a part of Op home and community division,
the Huntington Beach, California based company specializes in
how calls, and medical behavioral, social and pal
care for individuals with multiple chronic conditions across
more than 35 states.
Opt demand its subsidiaries have conducted workforce reductions
multiple times over the past year, including at
provider facilities in Seattle with Virginia and San
Antonio. In August, Med express, clinics, a chain
of urgent care clinics,
eliminated all registered nursing positions at nearly a
hundred and fifth facilities, med express is owned
by Opt. In April, Opt shutter its telehealth
division. And in May, the company said would
close the change healthcare facility in Toledo, Ohio,
resulting in the termination of 129
employees.
Would Well, United Health group Ceo said the
company was over optimistic about how quickly business
would return to normal following the cyber attack
on change health care. The February ransom attack
delayed payment and claims processing for health care
providers around the country as change handles an
estimated 1 in 3 health
transactions.
United Health Ceo, Andrew Witty said in a
July sixteenth earnings call with investors that the
company was a little optimistic in hindsight at
the pace in which we thought people would
come back in terms of putting their flow
through the system once it was reconnected. He
said I think as we've looked at to
the last several weeks, that momentum and pace
in particular as we look at new clients
come in as well as returning clients. We
feel good about where we are now. So
I think we were probably a little over
optimistic 3 months ago.
Executive said, change, changes It systems are mostly
restored and that the company continues to catch
up on its claims backlog.
While medical costs are on the rise within
El health Medicaid business. On the company's second
quarter earnings call with investors on July seventeenth.
Cfo, Mark Kaye said the company is seen
signs of increased
within outpatient home health radiology
and other areas.
Medicaid red termination have left elements with a
higher acuity Medicaid
membership. In 20 23, states began the process
of dis enrolling Medicaid enroll these for the
first time since 20 20.
As of July twelfth, more than 24000000 people
have have been dis through the red
process.
And those who remain enrolled tend to have
more health needs
thereby driving up costs in the program.
According to El second quarter earnings reports, its
Medicaid membership drop to 23 percent from 06/23/2023
to 9000000 people.
Mister Kay said that some Medicaid
beneficiaries who know they will be ineligible for
the program, maybe seeking care before they lose
their benefits, which is also driving up utilization.
L reported a medical loss ratio of 86.3
percent in the second quarter. That's down from
86.4
percent in 20 23.
The company expects its a full year a
loss ratio to land to the top end
of its projected range.
Well Florida has awarded more Medicaid contract to
3 additional payers. On July eighteenth, Ae, United
Healthcare and Molina were all awarded Medicaid contracts
after originally being denied by state.
In April, Florida awarded 6 year contracts to
Florida Community care, Human, El,
community care plan and Cent.
At No Molina, United Health and Am health
Ke held existing contracts. And were not originally
chosen for new ones.
Center, Carol Alliance and imagine care also submitted
bids, but we're not selected. Florida's Medicaid managed
program provides health coverage to more than 3400000.0
people, and those current contracts expire at the
end of this year.
Well, if Gl p 1 drugs are approved
to treat sleep apnea,
insurers and self insured employers may be more
likely to cover those costs.
That's according to a Wall Street Journal report
from July sixteenth.
Eli Lilly, which manufacturers z bound, said it
plans to seek wider approval for the drug
after study showed it could alleviate symptoms of
sleep apnea.
Lilly is working to build a quote wall
of evidence to prove to ensure that the
drugs have benefits beyond just weight loss.
More than 30000000 Americans have sleep apnea, which
can lead long term complications such as heart
problems. If that bound is approved to treat
sleep apnea, sales could rise by 5000000000 dollars
a year.
Gl 1 drugs approved for weight loss cost
upwards of a thousand dollars a month without
insurance coverage. And some employers and ensure have
dropped coverage of the drugs in recent months,
citing their high cost.
Federal law prevents medicare from pain for drugs
for weight loss only, though, it can cover
the drugs if are used to treat other
conditions. The Fda could issue a decision on
is that bounds used to treat a sleep
apnea by the end of this year.
Well Cms has issued new policies aimed at
blocking
unauthorized changes from brokers when enrolling individuals on
the state and federal health insurance exchanges.
Effective of immediately, Cms said July nineteenth it
is blocking agents and brokers through making changes
to an individual's exchange enrollment status, unless they
are already associated with that enrollment. Una associated
or new agents and brokers will need to
conduct a 3 way call with the consumer
and an
call center to make any changes or direct
the enroll lead to make those changes themselves.
Cms said in the first 6 months of
this year, it has received nearly 74000
complaints,
about a plan being changed without the enroll
lee's consent, and another a hundred and 35000
complaint received by the agency, alleged that individuals
were enrolled in a plan without their consent.
Since June 20 first, Cms has suspended 200
marketplace agents for reasonable suspicion of fraud or
abusive conduct related to enrollment issues.
And finally, Human has acquired a minority stake
in health pilot, which is an Ai powered
Medicare
enrollment platform.
Health pilot was founded in 20 20 and
is an online Medicare Advantage broker platform.
The company uses an Ai powered platform to
recommend beneficiaries, the best plans based on their
health needs, choices for physicians, drug utilization and
cost preferences.
It will remain payer agnostic after Human investment
in the financial due terms of the deal
was not disclosed.
Other Medicare advantage insurers have also invested in
online platforms to help beneficiaries enroll in their
plans recently.
In April, Cvs acquired Hello Health, a Medicare
Advantage broker platform.
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