Medical Group: Private Firms Shouldn’t Run Oklahoma’s Medicaid Program

Modern Healthcare: Oklahoma State Medical Association To Challenge State's Medicaid Managed-Care Program
The association plans to challenge the Oklahoma Health Care Authority's decision to allow UnitedHealthcare, Blue Cross and Blue Shield of Oklahoma, Humana Healthy Horizons and Centene Corp. subsidiary Oklahoma Complete Health to manage Medicaid benefits for the state's 903,000 enrollees come Oct. 1. The initiative, named SoonerSelect, covers lower-income adults, Temporary Assistance for Needy Families and the Children's Health Insurance Program. The group said it takes issue with private companies operating the state's Medicaid program, rather than the Health Care Authority. Through SoonerSelect, the state will pay private insurers under a capitated payment model, offering payers a set fee per enrollee to coordinate care and allowing payers to elect how they reimburse providers. The Oklahoma Health Care Authority currently reimburses providers through a fee-for-service model. (Tepper, 2/9)

Modern Healthcare: Northwell Sues Property Insurers For Not Covering Hundreds Of Millions In COVID-19 Losses
Northwell Health is suing two property insurers over their refusal to pay hundreds of millions of dollars' worth of claims the New York health system says it's owed for losses stemming from the COVID-19 pandemic. New York's largest private employer argued in its federal lawsuit against Lexington Insurance Co. and Interstate Fire & Casualty Co. that the policies it purchased are designed to cover "exactly" the type of losses and expenses it sustained during the pandemic. New York City, where Northwell's facilities are located, was hit hard early on in the crisis, with approximately 200,000 coronavirus cases reported during the first three months alone. (Bannow, 2/9)

Modern Healthcare: AdventHealth May Be Liable For Non-Employed Physician, Appellate Court Rules
AdventHealth may be liable for purportedly suspect treatment advice offered by a non-employed physician, a Florida appellate court found. The state appeals court on Friday ruled that the consent agreement disavowing a physician-hospital relationship wasn't clear, which could open the door for the Altamonte Springs, Fla.-based health system to be held liable for the care. A Florida trial court previously absolved AdventHealth from responsibility for the patient's post-operative complications because, in part, the doctor was an independent contractor and Advent didn't influence treatment decisions. (Kacik, 2/9)

Modern Healthcare: Centene Reports $12 Million Loss In Q4
Centene reported a $12 million loss during its fourth-quarter in 2020, with higher than expected costs related to the COVID-19 pandemic and an extra $200 million state Medicaid risk-corridor expense cutting into its bottom-line. During the same period in 2019, the St. Louis-based insurer booked $209 million in profits. Additionally, CEO Michael Neidorff said Centene will eliminate 1,500 people from its workforce or about 6% of the company. He said the restructuring plan was announced in December and was primarily due to employee overlap, thanks to the company's recent acquisitions. (Tepper, 2/9)

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Charlotte Observer: Atrium Releases New Look At Medical School Coming To Charlotte 
Atrium Health released new renderings for a planned Charlotte medical school on Tuesday, while promising more information on the school’s location next month. Atrium Health officially combined with Wake Forest Baptist Health, including the Wake Forest School of Medicine, in October. (Smoot, 2/9)