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This is Jacob Emerson with the Becker pair

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issues podcast podcasts. Here's your bi weekly industry

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news briefing for July 20. Second.

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Former employees with United Health Group's Opt and

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its subsidiaries took to social media beginning July

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eighteenth regarding another reduction in force within recent

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months that those employees say occurred across parts

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of the company.

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Social media posts from terminated employees indicate that

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positions at landmark health have been affected,

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including behavioral health and social workers, along with

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nurse practitioners that In 20 22, Landmark became

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a part of Op home and community division,

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the Huntington Beach, California based company specializes in

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how calls, and medical behavioral, social and pal

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care for individuals with multiple chronic conditions across

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more than 35 states.

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Opt demand its subsidiaries have conducted workforce reductions

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multiple times over the past year, including at

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provider facilities in Seattle with Virginia and San

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Antonio. In August, Med express, clinics, a chain

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of urgent care clinics,

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eliminated all registered nursing positions at nearly a

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hundred and fifth facilities, med express is owned

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by Opt. In April, Opt shutter its telehealth

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division. And in May, the company said would

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close the change healthcare facility in Toledo, Ohio,

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resulting in the termination of 129

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employees.

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Would Well, United Health group Ceo said the

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company was over optimistic about how quickly business

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would return to normal following the cyber attack

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on change health care. The February ransom attack

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delayed payment and claims processing for health care

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providers around the country as change handles an

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estimated 1 in 3 health

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transactions.

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United Health Ceo, Andrew Witty said in a

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July sixteenth earnings call with investors that the

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company was a little optimistic in hindsight at

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the pace in which we thought people would

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come back in terms of putting their flow

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through the system once it was reconnected. He

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said I think as we've looked at to

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the last several weeks, that momentum and pace

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in particular as we look at new clients

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come in as well as returning clients. We

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feel good about where we are now. So

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I think we were probably a little over

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optimistic 3 months ago.

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Executive said, change, changes It systems are mostly

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restored and that the company continues to catch

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up on its claims backlog.

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While medical costs are on the rise within

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El health Medicaid business. On the company's second

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quarter earnings call with investors on July seventeenth.

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Cfo, Mark Kaye said the company is seen

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signs of increased

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within outpatient home health radiology

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and other areas.

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Medicaid red termination have left elements with a

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higher acuity Medicaid

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membership. In 20 23, states began the process

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of dis enrolling Medicaid enroll these for the

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first time since 20 20.

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As of July twelfth, more than 24000000 people

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have have been dis through the red

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process.

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And those who remain enrolled tend to have

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more health needs

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thereby driving up costs in the program.

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According to El second quarter earnings reports, its

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Medicaid membership drop to 23 percent from 06/23/2023

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to 9000000 people.

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Mister Kay said that some Medicaid

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beneficiaries who know they will be ineligible for

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the program, maybe seeking care before they lose

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their benefits, which is also driving up utilization.

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L reported a medical loss ratio of 86.3

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percent in the second quarter. That's down from

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86.4

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percent in 20 23.

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The company expects its a full year a

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loss ratio to land to the top end

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of its projected range.

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Well Florida has awarded more Medicaid contract to

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3 additional payers. On July eighteenth, Ae, United

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Healthcare and Molina were all awarded Medicaid contracts

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after originally being denied by state.

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In April, Florida awarded 6 year contracts to

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Florida Community care, Human, El,

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community care plan and Cent.

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At No Molina, United Health and Am health

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Ke held existing contracts. And were not originally

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chosen for new ones.

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Center, Carol Alliance and imagine care also submitted

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bids, but we're not selected. Florida's Medicaid managed

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program provides health coverage to more than 3400000.0

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people, and those current contracts expire at the

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end of this year.

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Well, if Gl p 1 drugs are approved

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to treat sleep apnea,

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insurers and self insured employers may be more

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likely to cover those costs.

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That's according to a Wall Street Journal report

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from July sixteenth.

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Eli Lilly, which manufacturers z bound, said it

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plans to seek wider approval for the drug

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after study showed it could alleviate symptoms of

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sleep apnea.

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Lilly is working to build a quote wall

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of evidence to prove to ensure that the

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drugs have benefits beyond just weight loss.

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More than 30000000 Americans have sleep apnea, which

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can lead long term complications such as heart

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problems. If that bound is approved to treat

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sleep apnea, sales could rise by 5000000000 dollars

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a year.

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Gl 1 drugs approved for weight loss cost

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upwards of a thousand dollars a month without

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insurance coverage. And some employers and ensure have

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dropped coverage of the drugs in recent months,

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citing their high cost.

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Federal law prevents medicare from pain for drugs

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for weight loss only, though, it can cover

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the drugs if are used to treat other

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conditions. The Fda could issue a decision on

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is that bounds used to treat a sleep

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apnea by the end of this year.

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Well Cms has issued new policies aimed at

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blocking

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unauthorized changes from brokers when enrolling individuals on

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the state and federal health insurance exchanges.

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Effective of immediately, Cms said July nineteenth it

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is blocking agents and brokers through making changes

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to an individual's exchange enrollment status, unless they

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are already associated with that enrollment. Una associated

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or new agents and brokers will need to

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conduct a 3 way call with the consumer

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and an

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call center to make any changes or direct

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the enroll lead to make those changes themselves.

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Cms said in the first 6 months of

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this year, it has received nearly 74000

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complaints,

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about a plan being changed without the enroll

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lee's consent, and another a hundred and 35000

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complaint received by the agency, alleged that individuals

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were enrolled in a plan without their consent.

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Since June 20 first, Cms has suspended 200

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marketplace agents for reasonable suspicion of fraud or

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abusive conduct related to enrollment issues.

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And finally, Human has acquired a minority stake

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in health pilot, which is an Ai powered

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Medicare

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enrollment platform.

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Health pilot was founded in 20 20 and

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is an online Medicare Advantage broker platform.

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The company uses an Ai powered platform to

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recommend beneficiaries, the best plans based on their

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health needs, choices for physicians, drug utilization and

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cost preferences.

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It will remain payer agnostic after Human investment

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in the financial due terms of the deal

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was not disclosed.

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Other Medicare advantage insurers have also invested in

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online platforms to help beneficiaries enroll in their

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plans recently.

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In April, Cvs acquired Hello Health, a Medicare

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Advantage broker platform.

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If you'd like the latest health insurance industry

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