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This is Jacob Emerson with the Becker's Payer

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Issues podcast.

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Here's your biweekly industry news briefing for July

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31st.

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UnitedHealth Group's Change Healthcare

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has begun sending out letters to individuals

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affected by the February ransomware attack.

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On July 29th, Change began mailing written notices

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to individuals affected by the incident.

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Change is committed to notifying potentially impacted individuals

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as quickly as possible on a rolling basis

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given the volume and complexity of the data

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involved. That's according to a statement from UnitedHealth.

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Change Healthcare also reported the ransomware attack to

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HHS's

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data breach portal. This comes after change said

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back in April that an initial sampling of

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the breach data showed the attack compromised, protected

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health information,

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and personally identifiable information from a large swath

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of the country.

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Wells Humana reported 6 $179,000,000

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in profits in the Q2

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of this year. The company published its 2nd

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quarter earnings report on July 31st and beat

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investor expectations.

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In the Q2 of last year, Humana posted

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$559,000,000

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in profits.

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Total revenue in the Q2 was $29,500,000,000.

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That's up 10%

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year over year. Humana's medical loss ratio was

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89% in the Q2.

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Total medical membership in the Q2 was 16,300,000

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people. That's down 4.8%

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year over year. Medicare Advantage membership grew to

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nearly 6,200,000

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people. The company raised its individual Medicare Advantage

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membership growth expectations by 75,000,

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predicting to add around

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225,000

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more members this year.

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Well, Centene says it will exit a handful

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of state Medicare Advantage markets in 2025.

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On July 26th call with investors, its CEO,

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Sarah London, said the exits are designed to

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align with the company's long term strategy. She

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said, we think the team has done a

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really good job in terms of thought we

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designing

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bids consistent with our long term strategy

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even in a challenging rate year. We're being

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thoughtful about how to streamline that book and

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further alignment with our Medicaid footprint

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because that's where the puck is going. Centene

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is focused on MA plans for dually eligible

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beneficiaries.

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Other payers have also said they plan to

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exit MA markets in 2025

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as they face rising medical costs and a

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tougher reimbursement environment, including

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Humana and

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CVS Health. Centene also named

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Nathan Landsbaum as its next CEO of Markets

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and Medicaid.

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He is the CEO of Sunshine Health, which

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is Centene's Medicaid subsidiary in Florida. And the

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company's current CEO of Markets and Medicaid, Dave

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Thomas, will leave Centene

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in December.

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Well, Blue Cross Blue Shield of Vermont says

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premium hikes are needed this year to stay

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financially solvent.

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In May, the company asked state regulators to

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approve the highest ever premium increases for individual

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and small group plans in

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Vermont exchange market.

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In July, the company said it was placed

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in the, quote, unprecedented in situation of amending

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its request to raise premiums even higher.

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The company says its claim costs have increased

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significantly since May, draining reserves and leaving the

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company in a fragile financial state.

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Its CEO, Don George, wrote in a letter

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to Becker's, these increases are troubling for all

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of us and have positioned us between 2

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extraordinary pressures,

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the sky right skyrocketing

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increase in health care costs and the difficulty

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of providing affordable health insurance plans for our

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members. He said, unfortunately,

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the high demand for medical services, increasing prices

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at hospitals,

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exponential growth in drug prices, and new state

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laws

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are all forcing higher premiums to pay for

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the cost of care for Vermonters.

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Vermont's commissioner of insurance wrote that BCBS needs

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to contribute more to its reserve funds to

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stay financially solvent.

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Insurers must maintain adequate reserve funds to pay

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for unexpectedly

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high medical claims

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or other unforeseen

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events.

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BCBS has proposed upping its reserve contribution to

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7%,

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up from 3 in its original proposal.

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Those contributions are funded by premiums.

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If approved, premiums

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for individual plans would increase 20%,

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and group market premiums would increase 23% in

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2025.

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The market accounts for 18% of the company's

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membership,

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but 50%

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of its reserve needs.

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Other markets will have proportional increases to cover

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the increased reserved funds.

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And finally, 7 insurers, at least 7 insurers,

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are exiting Medicare Advantage Markets in 2025,

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a number that is likely to grow in

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the fall. There's just under 4,000 individual individual

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MA plans available nationwide this year, and the

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average number of plans available to beneficiaries is

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43, which is unchanged from last year.

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In terms of insurers that will be exiting

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markets next year, Blue Cross of Arizona is

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not going to be offering MA prescription drug

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plans in the states next

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year. We mentioned that Centene, Aetna, and Humana

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will all be exiting an unspecified number of

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markets next year as they focus more on

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profitability.

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Blue Cross of Kansas City is exiting the

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Medicare Advantage market entirely.

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ClearSpring Health will withdraw its Medicare Advantage prescription

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drug plans from South Carolina and Virginia.

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And finally, at the very

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start of this year, Cigna Group reached a

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deal to sell its Medicare business to Health

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Care Service Corporation, which owns 5 Blue Cross

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Plans. A deal was worth just over $3,000,000,000.

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It's expected to close in the Q1 of

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2025, and that includes almost

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600,000

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Medicare Advantage members.

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